Provider Demographics
NPI:1184893695
Name:VALLEY EYE CLINIC PC
Entity type:Organization
Organization Name:VALLEY EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:540-743-5670
Mailing Address - Street 1:30 COTTAGE DR
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-9201
Mailing Address - Country:US
Mailing Address - Phone:540-743-5670
Mailing Address - Fax:540-743-2342
Practice Address - Street 1:30 COTTAGE DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-9201
Practice Address - Country:US
Practice Address - Phone:540-743-5670
Practice Address - Fax:540-743-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
VA0618000037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009230343Medicaid
U02685Medicare UPIN
0303600001Medicare NSC
VA009230343Medicaid