MEDICARE: VALLE VISTA OPTICAL 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	:	1700147493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLE VISTA OPTICAL INC.

Provider Business Mailing Address
First Line	:	913 N ED CAREY DR STE B
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-9203
Country	:	US
Telephone Number	:	956-440-1333
Fax Number	:	956-440-1330

Provider Business Practice Location Address
First Line	:	2000 S EXPRESSWAY 83 STE F3
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-5904
Country	:	US
Telephone Number	:	956-440-1333
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LANNING BLISH
Credential	:
Telephone Number	:	956-244-5322

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	01/29/2024

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