MEDICARE: VALLEY OPTICIANS 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1235110446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY OPTICIANS INC.

Provider Business Mailing Address
First Line	:	780 NW GARDEN VALLEY BLVD
Second Line	:	PO BOX 970
City	:	ROSEBURG
State	:	OR
Zip	:	97470-6528
Country	:	US
Telephone Number	:	541-672-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 NW GARDEN VALLEY BLVD
Second Line	:	SUITE 50B-1
City	:	ROSEBURG
State	:	OR
Zip	:	97470-6528
Country	:	US
Telephone Number	:	541-672-5400
Fax Number	:

Authorized Official
Title or Position	:	DISPENCING OPTICIAN
Name	:	MR. TODD L. BARNETT
Credential	:
Telephone Number	:	541-672-5400

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	01/14/2008

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