Provider Demographics
NPI:1477760163
Name:VALENTINE, HENRY RICHARD (OD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:RICHARD
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 ERDMAN WAY
Mailing Address - Street 2:205
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1840
Mailing Address - Country:US
Mailing Address - Phone:978-696-5674
Mailing Address - Fax:978-400-7836
Practice Address - Street 1:80 ERDMAN WAY
Practice Address - Street 2:205
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-696-5674
Practice Address - Fax:978-400-7836
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2012-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU08677Medicare UPIN