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General NPI Number Information
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NPI Number | 1396059549
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Entity Type | Organization
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Legal Business Name | VALLEY EYE CLINIC & OPTICAL P.A.
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 901 E 3RD ST
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City | WASHINGTON
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State | MO
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Zip | 63090-3010
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Country | US
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Telephone | 636-390-3999
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Fax | 636-390-3959
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Provider Business Mailing Address
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Address Line | 1431 BEAM AVE
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1064
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Country | US
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Telephone | 612-486-1749
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Fax | 612-486-1750
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Authorized Official
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Title or Position | OWNER
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Name | DAVID H HESS
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Credential | OD
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Telephone | 612-486-1749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2776
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License Number State | MN
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