Provider Demographics
NPI:1295953453
Name:VALLEY HI OPTICAL INC.
Entity type:Organization
Organization Name:VALLEY HI OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-674-9461
Mailing Address - Street 1:410 VALLEY HI DR
Mailing Address - Street 2:SUITE 201 A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-4610
Mailing Address - Country:US
Mailing Address - Phone:210-674-9461
Mailing Address - Fax:
Practice Address - Street 1:410 VALLEY HI DR
Practice Address - Street 2:SUITE 201 A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-4610
Practice Address - Country:US
Practice Address - Phone:210-674-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7427090406332H00000X
TX156FC0800X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019793101Medicaid