Provider Demographics
NPI:1700147493
Name:VALLE VISTA OPTICAL INC.
Entity type:Organization
Organization Name:VALLE VISTA OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANNING
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-244-5322
Mailing Address - Street 1:913 N ED CAREY DR STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9203
Mailing Address - Country:US
Mailing Address - Phone:956-440-1333
Mailing Address - Fax:956-440-1330
Practice Address - Street 1:2000 S EXPRESSWAY 83 STE F3
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-5904
Practice Address - Country:US
Practice Address - Phone:956-440-1333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier