Provider Demographics
NPI:1083205587
Name:PROFESSIONAL OPTOMETRY VISION CARE PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL OPTOMETRY VISION CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-499-8811
Mailing Address - Street 1:77 VETERANS MEMORIAL HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3410
Mailing Address - Country:US
Mailing Address - Phone:631-499-8811
Mailing Address - Fax:631-499-8846
Practice Address - Street 1:77 VETERANS MEMORIAL HWY STE 6
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3410
Practice Address - Country:US
Practice Address - Phone:631-499-8811
Practice Address - Fax:631-499-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty