Provider Demographics
NPI:1275964264
Name:VALLEY EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:VALLEY EYE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CZYZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-405-2120
Mailing Address - Street 1:12437 N 80TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5204
Mailing Address - Country:US
Mailing Address - Phone:602-405-2120
Mailing Address - Fax:623-551-9120
Practice Address - Street 1:6145 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1940
Practice Address - Country:US
Practice Address - Phone:602-973-6567
Practice Address - Fax:623-551-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1118152W00000X, 152WC0802X, 152WP0200X
AZ1146152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU89382Medicare UPIN
AZU83319Medicare UPIN