Provider Demographics
NPI:1275655391
Name:VALLEY EYE CARE P C
Entity Type:Organization
Organization Name:VALLEY EYE CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-754-6222
Mailing Address - Street 1:1505 NW HARRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5816
Mailing Address - Country:US
Mailing Address - Phone:541-754-6222
Mailing Address - Fax:541-757-2055
Practice Address - Street 1:1505 NW HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5816
Practice Address - Country:US
Practice Address - Phone:541-754-6222
Practice Address - Fax:541-757-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1046ATI152W00000X
OR2674ATI152W00000X
OR3026ATI152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR055502000OtherBLUE CROSS
OR055502000OtherBLUE CROSS
ORR109917Medicare PIN