Provider Demographics
NPI:1689794166
Name:VALENTINO, TONY TED (OD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:TED
Last Name:VALENTINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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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:31904-3412
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:31904-3412
Practice Address - Country:US
Practice Address - Phone:706-324-3029
Practice Address - Fax:706-324-1262
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1297152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU98460Medicare UPIN
GA41ZCFMBMedicare PIN