Provider Demographics
NPI:1427230465
Name:ANTELOPE VALLEY FAMILY OPTOMETRY, INC
Entity Type:Organization
Organization Name:ANTELOPE VALLEY FAMILY OPTOMETRY, INC
Other - Org Name:VALENCIA EYECARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-294-2733
Mailing Address - Street 1:25172 RYE CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3488
Mailing Address - Country:US
Mailing Address - Phone:661-294-2733
Mailing Address - Fax:661-294-2701
Practice Address - Street 1:25172 RYE CANYON RD
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3488
Practice Address - Country:US
Practice Address - Phone:661-294-2733
Practice Address - Fax:661-294-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11428T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19987Medicare PIN