Provider Demographics
NPI:1154474179
Name:BALOGH, VALERIE J (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:J
Last Name:BALOGH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 45TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3008
Mailing Address - Country:US
Mailing Address - Phone:219-924-6300
Mailing Address - Fax:
Practice Address - Street 1:3737 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3008
Practice Address - Country:US
Practice Address - Phone:219-924-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410007399OtherRAILROAD MEDICARE
IN251010BMedicare PIN
IN410007399OtherRAILROAD MEDICARE
IN706970Medicare ID - Type Unspecified