Provider Demographics
NPI:1588790406
Name:INTERMOUNTAIN EYE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:INTERMOUNTAIN EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-504-1530
Mailing Address - Street 1:510 HIGHLAND AVE
Mailing Address - Street 2:RURAL ROUTE #5
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9079
Mailing Address - Country:US
Mailing Address - Phone:570-357-7543
Mailing Address - Fax:570-586-3937
Practice Address - Street 1:4 MEADOW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2337
Practice Address - Country:US
Practice Address - Phone:570-504-1530
Practice Address - Fax:570-504-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041945L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty