Organization
VALLEY VISION CLINIC PS
Active
Other names
Valley Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT ANTHONY DUNN (OFFICE MANAGER)
(509) 529-2020
Entity
Organization
Contact information
Practice address
22 W MAIN ST, WALLA WALLA, WA 99362
(509) 529-2020
(509) 529-2115
Mailing address
PO BOX 1138, WALLA WALLA, WA 99362
(509) 529-2020
(509) 529-2115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001300045
MC SUPPLY CIGNA DMERC REG
—
01
—
0067000
DEPT OF LABOR AND INDUSTR
—
01
—
01300045
CIGNA
—
01
—
2576
GROUP HEALTH
—
05
—
2911402
—
WA
01
—
5870377
AETNA
—
01
—
610605300
DEPT OF LABOR SEATTLE DFE
—
01
—
8886644808
COMM HEALTH PLAN OF WASH
—
01
—
CO3376
TRAVELERS MEDICARE RETIRE
—
Enumeration date
03/23/2006
Last updated
10/08/2020
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