Provider Demographics
NPI:1558320838
Name:VALLEY VISION CLINIC PS
Entity Type:Organization
Organization Name:VALLEY VISION CLINIC PS
Other - Org Name:VALLEY VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-529-2020
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-529-2020
Mailing Address - Fax:509-529-2115
Practice Address - Street 1:22 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-529-2020
Practice Address - Fax:509-529-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5870377OtherAETNA
0067000OtherDEPT OF LABOR AND INDUSTR
610605300OtherDEPT OF LABOR SEATTLE DFE
8886644808OtherCOMM HEALTH PLAN OF WASH
01300045OtherCIGNA
WA2911402Medicaid
CO3376OtherTRAVELERS MEDICARE RETIRE
001300045OtherMC SUPPLY CIGNA DMERC REG
2576OtherGROUP HEALTH
001300045OtherMC SUPPLY CIGNA DMERC REG
CO3376OtherTRAVELERS MEDICARE RETIRE