# HEAVENLY VISION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BLUE VALLEY VISION LLC
- **Other names:** Blue Valley Vision
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104373265
- **Legal business name:** BLUE VALLEY VISION LLC
- **Authorized official:** MR. TIMOTHY JAMES VELEKEI SR. OPTICIAN (OPTICIAN / OWNER)
- **Authorized official phone:** (610) 432-7000

## Contact information

- **Practice address:** 455 BLUE VALLEY DR, BANGOR, PA 18013
- **Practice address phone:** (610) 432-7000
- **Mailing address:** 455 BLUE VALLEY DR, BANGOR, PA 18013-1513
- **Mailing address phone:** (610) 432-7000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | 046078 | PA | Yes |

## Other

- **Enumeration date:** 09/07/2016
- **Last updated:** 09/07/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 13658572 | CAQH | PA |