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General NPI Number Information
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NPI Number | 1619168267
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Entity Type | Organization
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Legal Business Name | VALLEY VISION CLINIC LTD
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 2200 SO WASHINGTON ST
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City | GRAND FORKS
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State | ND
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Zip | 58201
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Country | US
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Telephone | 701-775-3135
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Fax | 701-772-8161
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Provider Business Mailing Address
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Address Line | 2200 SO WASHINGTON ST
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City | GRAND FORKS
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State | ND
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Zip | 58201
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Country | US
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Telephone | 701-775-3135
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Fax | 701-772-8161
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JASON M SCHAFF
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Credential | OD
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Telephone | 701-775-3135
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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 |
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License Number State |
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