Healthcare Provider Details

I. General information

NPI: 1639331523
Provider Name (Legal Business Name): VALMOR OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 WASHINGTON BLVD
OGDEN UT
84404-6321
US

IV. Provider business mailing address

404 WASHINGTON BLVD
OGDEN UT
84404-6321
US

V. Phone/Fax

Practice location:
  • Phone: 801-866-0414
  • Fax: 801-866-0411
Mailing address:
  • Phone: 801-866-0414
  • Fax: 801-866-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1014662
License Number StateUT

VIII. Authorized Official

Name: MRS. ANA M. VALENZUELA
Title or Position: VICE -PRESIDENT
Credential:
Phone: 801-866-0414