Provider Demographics
NPI:1467513671
Name:TONY VALENTINO OD PC
Entity Type:Organization
Organization Name:TONY VALENTINO OD PC
Other - Org Name:DRS HUTCHINS & VALENTINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:TED
Authorized Official - Last Name:VALENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-324-3029
Mailing Address - Street 1:5624 WHITESVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9055
Mailing Address - Country:US
Mailing Address - Phone:706-324-3029
Mailing Address - Fax:706-324-1262
Practice Address - Street 1:5624 WHITESVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9055
Practice Address - Country:US
Practice Address - Phone:706-324-3029
Practice Address - Fax:706-324-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6315Medicare PIN
GA5269680001Medicare NSC
GADD7860Medicare PIN