Provider Demographics
NPI:1780797613
Name:VALLEY EYE CARE INC.
Entity type:Organization
Organization Name:VALLEY EYE CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLYDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-242-6888
Mailing Address - Street 1:1241 E NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4277
Mailing Address - Country:US
Mailing Address - Phone:602-242-6888
Mailing Address - Fax:602-242-4654
Practice Address - Street 1:1111 E NORTHERN AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4188
Practice Address - Country:US
Practice Address - Phone:602-242-6888
Practice Address - Fax:602-242-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1522152WV0400X, 156FC0800X, 156FC0801X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116316Medicare PIN