Provider Demographics
NPI:1326297169
Name:ADVANCED VALLEY EYE ASSOCIATES
Entity Type:Organization
Organization Name:ADVANCED VALLEY EYE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:530-757-6000
Mailing Address - Street 1:2035 LYNDELL TERRACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-757-6000
Mailing Address - Fax:530-668-9560
Practice Address - Street 1:2035 LYNDELL TERRACE
Practice Address - Street 2:SUITE 100
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-757-6000
Practice Address - Fax:530-668-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50646207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3159116OtherCORPORATE ID
CA9743438Medicaid
CA3159116OtherCORPORATE ID