Provider Demographics
NPI:1568725232
Name:VALENCIC, ASHLEY (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VALENCIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 ASHWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7143
Mailing Address - Country:US
Mailing Address - Phone:515-440-4610
Mailing Address - Fax:515-440-4611
Practice Address - Street 1:5970 ASHWORTH RD
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7143
Practice Address - Country:US
Practice Address - Phone:515-440-4610
Practice Address - Fax:515-440-4611
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1705152W00000X
IA117369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOPT0003304OtherLICENSE