Provider Demographics
NPI:1316501471
Name:EL VALLE OPTICAL, INC.
Entity type:Organization
Organization Name:EL VALLE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-551-0707
Mailing Address - Street 1:1940 CAMPBELL ST.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209
Mailing Address - Country:US
Mailing Address - Phone:313-551-0707
Mailing Address - Fax:313-551-0708
Practice Address - Street 1:1940 CAMPBELL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209
Practice Address - Country:US
Practice Address - Phone:313-551-0707
Practice Address - Fax:313-551-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty