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General NPI Number Information
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NPI Number | 1790325462
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Entity Type | Organization
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Legal Business Name | VALLEY OPTOMETRY, PLC
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 198 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3020
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Country | US
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Telephone | 802-775-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 198 N MAIN ST
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City | RUTLAND
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State | VT
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Zip | 05701-3020
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Country | US
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Telephone | 802-775-2368
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Fax | 802-775-2369
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | LEANNA OLENNIKOV
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Credential |
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Telephone | 360-521-5768
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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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