Provider Demographics
NPI:1407043177
Name:VALLEY VISION CENTER LTD
Entity Type:Organization
Organization Name:VALLEY VISION CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-365-2020
Mailing Address - Street 1:2197 BLACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4713
Mailing Address - Country:US
Mailing Address - Phone:630-365-2020
Mailing Address - Fax:630-365-9828
Practice Address - Street 1:2197 BLACKBERRY DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4713
Practice Address - Country:US
Practice Address - Phone:630-365-2020
Practice Address - Fax:630-365-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5367030001Medicare NSC
ILIL6941Medicare PIN