Provider Demographics
NPI:1265413587
Name:URBAN, VALERIE S (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:S
Last Name:URBAN
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51096
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-2096
Mailing Address - Country:US
Mailing Address - Phone:864-295-3550
Mailing Address - Fax:864-295-3242
Practice Address - Street 1:3529 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7515
Practice Address - Country:US
Practice Address - Phone:864-295-3550
Practice Address - Fax:864-295-3242
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13000Medicaid
SCU836384347Medicare PIN
SCD13000Medicaid