Provider Demographics
NPI:1164604393
Name:VALLEY OPTICAL
Entity Type:Organization
Organization Name:VALLEY OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-794-2020
Mailing Address - Street 1:9011 W SAHARA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4800
Mailing Address - Country:US
Mailing Address - Phone:702-794-2020
Mailing Address - Fax:702-732-4108
Practice Address - Street 1:9011 W SAHARA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4800
Practice Address - Country:US
Practice Address - Phone:702-794-2020
Practice Address - Fax:702-732-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier