Provider Demographics
NPI:1215003959
Name:VALLEY OPTICAL, INC.
Entity Type:Organization
Organization Name:VALLEY OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HEIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-829-2291
Mailing Address - Street 1:P.O. BOX 371
Mailing Address - Street 2:524 E. MORGAN STREET
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1544
Mailing Address - Country:US
Mailing Address - Phone:812-829-2291
Mailing Address - Fax:812-829-6131
Practice Address - Street 1:524 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1544
Practice Address - Country:US
Practice Address - Phone:812-829-2291
Practice Address - Fax:812-829-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
IN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100195400AMedicaid
IN0506220001Medicare NSC
IN0506220001Medicare PIN