Basic Information
| Provider Information | |||||||||
| NPI: | 1235354515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST VALLEY VISION CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 570 RIVERSTONE WAY | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997092939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074794700 | ||||||||
| FaxNumber: | 9074575596 | ||||||||
| Practice Location | |||||||||
| Address1: | 4169 GEIST RD | ||||||||
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| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997093420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074794700 | ||||||||
| FaxNumber: | 9074575596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOYLE | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9074794700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | A160 | AK | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.