Healthcare Provider Details

I. General information

NPI: 1295953453
Provider Name (Legal Business Name): VALLEY HI OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 VALLEY HI DR SUITE 201 A
SAN ANTONIO TX
78227-4610
US

IV. Provider business mailing address

410 VALLEY HI DR SUITE 201 A
SAN ANTONIO TX
78227-4610
US

V. Phone/Fax

Practice location:
  • Phone: 210-674-9461
  • Fax:
Mailing address:
  • Phone: 210-674-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number7427090406
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. BRIAN HERNANDEZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 210-674-9461