Organization
APPLE VALLEY EYEWEAR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP TANNER ETCHELLS O.D. (OWNER/ PRESIDENT)
(760) 961-1919
Entity
Organization
Contact information
Practice address
13692 APPLE VALLEY RD, SUITE 170, APPLE VALLEY, CA 92308-4561
(760) 961-1919
(760) 961-1907
Mailing address
13692 APPLE VALLEY RD, SUITE 170, APPLE VALLEY, CA 92308-4561
(760) 961-1919
(760) 961-1907
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
5518T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0055181
—
CA
Enumeration date
03/02/2011
Last updated
04/29/2013
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