Provider Demographics
NPI:1790325462
Name:VALLEY OPTOMETRY, PLC
Entity Type:Organization
Organization Name:VALLEY OPTOMETRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLENNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-521-5768
Mailing Address - Street 1:198 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3020
Mailing Address - Country:US
Mailing Address - Phone:802-775-2368
Mailing Address - Fax:802-775-2369
Practice Address - Street 1:198 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3020
Practice Address - Country:US
Practice Address - Phone:802-775-2368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty