Provider Demographics
NPI:1376633768
Name:VALLEY EYE ASSOCIATES, PC
Entity type:Organization
Organization Name:VALLEY EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:907-373-0225
Mailing Address - Street 1:935 E WESTPOINT DR
Mailing Address - Street 2:STE 207
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-373-0225
Mailing Address - Fax:907-373-7776
Practice Address - Street 1:935 E WESTPOINT DR
Practice Address - Street 2:STE 207
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-0225
Practice Address - Fax:907-373-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR90152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1144295809OtherDR COON NPI
AKOD00902Medicaid
AKT67001Medicare UPIN
AK1144295809OtherDR COON NPI
AKOD00902Medicaid