Provider Demographics
NPI:1619168267
Name:VALLEY VISION CLINIC LTD
Entity Type:Organization
Organization Name:VALLEY VISION CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:701-775-3135
Mailing Address - Street 1:2200 SO WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-775-3135
Mailing Address - Fax:701-772-8161
Practice Address - Street 1:2200 SO WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-775-3135
Practice Address - Fax:701-772-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
234001OtherBCBS OF ND
801731OtherVISION SERVICE INC DIV OF
ND60081Medicaid
92037VAOtherBCBS OF MN
92042WAOtherBCBS OF MN
2100122OtherMEDICA
92037VAOtherBCBS OF MN
2100122OtherMEDICA
801731OtherVISION SERVICE INC DIV OF