Provider Demographics
NPI:1508527466
Name:WEST VALLEY DRY EYE
Entity Type:Organization
Organization Name:WEST VALLEY DRY EYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:OLSEN
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:623-692-8977
Mailing Address - Street 1:5550 W CAVEDALE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-6369
Mailing Address - Country:US
Mailing Address - Phone:623-692-8977
Mailing Address - Fax:623-583-2253
Practice Address - Street 1:13945 W GRAND AVE STE A101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2437
Practice Address - Country:US
Practice Address - Phone:623-931-2943
Practice Address - Fax:623-583-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty