Provider Demographics
NPI:1306874672
Name:VALLINO, GREGORY W (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:VALLINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 VILLAGE AT ELAND
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2284
Mailing Address - Country:US
Mailing Address - Phone:610-983-0841
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 113 VILLAGE AT ELAND
Practice Address - Street 2:SUITE 706
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:610-917-9999
Practice Address - Fax:610-917-9978
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG1131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA179532LG3Medicare ID - Type Unspecified
PAU36435Medicare UPIN