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General NPI Number Information
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NPI Number | 1891965851
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Entity Type | Organization
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Legal Business Name | PHILIP W VALENTINE OD INC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 739 SPRUCE AVE
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City | SIDNEY
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State | OH
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Zip | 45365-3360
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Country | US
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Telephone | 937-492-1990
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Fax | 937-492-7230
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Provider Business Mailing Address
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Address Line | 739 SPRUCE AVE PO BOX 179
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City | SIDNEY
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State | OH
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Zip | 45365-3360
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Country | US
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Telephone | 937-492-1990
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Fax | 937-492-7230
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP W VALENTINE
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Credential | OD
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Telephone | 937-492-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OH2815
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License Number State | OH
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