MEDICARE: WEST VALLEY OPTOMETRY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	09166T	CA

General Provider Information

NPI Number	:	1205982584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VALLEY OPTOMETRY, INC.

Provider Business Mailing Address
First Line	:	8391 TOPANGA CANYON BLVD
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91304-2343
Country	:	US
Telephone Number	:	818-348-4666
Fax Number	:	818-348-4283

Provider Business Practice Location Address
First Line	:	8391 TOPANGA CANYON BLVD
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91304-2343
Country	:	US
Telephone Number	:	818-348-4666
Fax Number	:	818-348-4283

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVIN R. MINIE
Credential	:	O.D.
Telephone Number	:	818-348-4666

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	03/26/2010

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