Provider Demographics
NPI:1780177006
Name:COLBY, VALERIE MARION (OD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MARION
Last Name:COLBY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELPHI
Mailing Address - State:IN
Mailing Address - Zip Code:46923-1327
Mailing Address - Country:US
Mailing Address - Phone:765-564-2800
Mailing Address - Fax:
Practice Address - Street 1:750 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1327
Practice Address - Country:US
Practice Address - Phone:765-564-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU18003041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist