Provider Demographics
NPI:1891965851
Name:PHILIP W VALENTINE OD INC
Entity Type:Organization
Organization Name:PHILIP W VALENTINE OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-492-1990
Mailing Address - Street 1:739 SPRUCE AVE
Mailing Address - Street 2:PO BOX 179
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3360
Mailing Address - Country:US
Mailing Address - Phone:937-492-1990
Mailing Address - Fax:937-492-7230
Practice Address - Street 1:739 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3360
Practice Address - Country:US
Practice Address - Phone:937-492-1990
Practice Address - Fax:937-492-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2815332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078679Medicaid
T46149Medicare UPIN
0847020001Medicare NSC
OH0078679Medicaid