Organization
VALLEY EYE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN MARIE JACOBS (BUSINESS MANAGER)
(920) 749-4058
Entity
Organization
Contact information
Practice address
21 PARK PL, APPLETON, WI 54914-8872
(920) 739-4361
(920) 739-6368
Mailing address
21 PARK PL, APPLETON, WI 54914-8872
(920) 739-4361
(920) 739-6368
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32681900
—
WI
Enumeration date
07/29/2006
Last updated
07/09/2021
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