Provider Demographics
NPI:1699830984
Name:VALLEY HEALTH TEAM, INC.
Entity Type:Organization
Organization Name:VALLEY HEALTH TEAM, INC.
Other - Org Name:VALLEY OPTOMETRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOYLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:559-693-2462
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:SAN JOAQUIN
Mailing Address - State:CA
Mailing Address - Zip Code:93660-0737
Mailing Address - Country:US
Mailing Address - Phone:559-693-2462
Mailing Address - Fax:559-692-4382
Practice Address - Street 1:942 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1743
Practice Address - Country:US
Practice Address - Phone:559-364-2980
Practice Address - Fax:559-326-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699830984Medicaid
CA551847Medicare ID - Type Unspecified