Provider Demographics
NPI:1225505878
Name:GREEN VALLEY OPTOMETRY
Entity Type:Organization
Organization Name:GREEN VALLEY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOFGRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-680-0055
Mailing Address - Street 1:749 SOUTH RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5509
Mailing Address - Country:US
Mailing Address - Phone:435-628-4464
Mailing Address - Fax:435-628-5015
Practice Address - Street 1:386 SOUTH GREEN VALLEY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3007
Practice Address - Country:US
Practice Address - Phone:831-724-1063
Practice Address - Fax:831-724-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty