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General NPI Number Information
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NPI Number | 1871978254
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW OPTOMETRY, P.C.
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 538 DELAWARE AVE
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City | PALMERTON
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State | PA
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Zip | 18071-1911
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Country | US
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Telephone | 610-826-2222
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Fax | 610-826-4001
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Provider Business Mailing Address
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Address Line | 538 DELAWARE AVE
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City | PALMERTON
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State | PA
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Zip | 18071-1911
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Country | US
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Telephone | 610-826-2222
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Fax | 610-826-4001
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL BALLIET
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Credential | OPTOMETRIST
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Telephone | 610-826-2222
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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 | OEG002270
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License Number State | PA
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