Provider Demographics
NPI:1336241827
Name:VALLEY VISION CENTER, INC.
Entity type:Organization
Organization Name:VALLEY VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-245-7850
Mailing Address - Street 1:950 NORTH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3259
Mailing Address - Country:US
Mailing Address - Phone:970-245-7850
Mailing Address - Fax:970-242-0281
Practice Address - Street 1:950 NORTH AVE STE 106
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3259
Practice Address - Country:US
Practice Address - Phone:970-245-7850
Practice Address - Fax:970-242-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODD8748OtherRAILROAD MEDICARE
COC802009Medicare PIN
CO5404370001Medicare NSC