Provider Demographics
NPI:1174588057
Name:VALLEY EYE, PC
Entity type:Organization
Organization Name:VALLEY EYE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:256-760-8484
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0430
Mailing Address - Country:US
Mailing Address - Phone:256-760-8484
Mailing Address - Fax:256-760-7272
Practice Address - Street 1:201 ROSA LN
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1770
Practice Address - Country:US
Practice Address - Phone:256-760-8484
Practice Address - Fax:256-760-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA55TA639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE68345Medicare UPIN
ALT87429Medicare UPIN
ALB59272Medicare UPIN
ALU96657Medicare UPIN
AL0639930001Medicare NSC