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General NPI Number Information
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NPI Number | 1952591810
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Entity Type | Organization
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Legal Business Name | VALE PARK EYE CLINIC, INC.
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 401 WALL ST SUITE C
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City | VALPARAISO
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State | IN
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Zip | 46383-2521
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Country | US
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Telephone | 219-464-2020
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Fax | 219-531-0730
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Provider Business Mailing Address
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Address Line | 401 WALL ST SUITE C
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City | VALPARAISO
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State | IN
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Zip | 46383-2521
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Country | US
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Telephone | 219-464-2020
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Fax | 219-531-0730
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOUIS CASTILLO BEJEC
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Credential | M.D.
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Telephone | 219-464-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01028497A
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License Number State | IN
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