Basic Information
| Provider Information | |||||||||
| NPI: | 1275964264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY EYE ASSOCIATES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12437 N 80TH PL | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852605204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024052120 | ||||||||
| FaxNumber: | 6235519120 | ||||||||
| Practice Location | |||||||||
| Address1: | 6145 N 35TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850171940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029736567 | ||||||||
| FaxNumber: | 6235519120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2013 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | CZYZ | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER/MANAGER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6024052120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1146 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152WC0802X | 1118 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WC0802X | 1146 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152WP0200X | 1118 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Pediatrics | 152WP0200X | 1146 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Pediatrics | 152W00000X | 1118 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.