Organization
HEAVENLY VISION
Active
Parent organization
BLUE VALLEY VISION LLC
Other names
Blue Valley Vision
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLUE VALLEY VISION LLC
Authorized official
MR. TIMOTHY JAMES VELEKEI SR. OPTICIAN (OPTICIAN / OWNER)
(610) 432-7000
Entity
Organization
Contact information
Practice address
455 BLUE VALLEY DR, BANGOR, PA 18013
(610) 432-7000
Mailing address
455 BLUE VALLEY DR, BANGOR, PA 18013-1513
(610) 432-7000
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
046078
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13658572
CAQH
PA
Enumeration date
09/07/2016
Last updated
09/07/2016
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