MEDICARE: BLUE VALLEY VISION LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740803006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE VALLEY VISION LLC

Provider Business Mailing Address
First Line	:	455 BLUE VALLEY DR
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-1513
Country	:	US
Telephone Number	:	610-452-2720
Fax Number	:	610-452-3199

Provider Business Practice Location Address
First Line	:	455 BLUE VALLEY DR
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-1513
Country	:	US
Telephone Number	:	610-452-2720
Fax Number	:	610-452-3199

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. TIMOTHY JAMES VELEKEI SR.
Credential	:
Telephone Number	:	610-452-2720

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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Directions to “BLUE VALLEY VISION LLC ” Practice Location

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