Apple Valley Eyewear, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

5518T Issued in CA

Legal business name

APPLE VALLEY EYEWEAR, INC.

Practice address

13692 Apple Valley Rd
Suite 170
Apple Valley, CA 92308-4561

Phone

(760) 961-1919

Fax

(760) 961-1907

NPI assigned

Mar 2, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Philip Tanner Etchells, O.D.

Title

Owner/ President

Phone

(760) 961-1919

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367193600000",
    "number": "1346548237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13692 APPLE VALLEY RD",
            "address_2": "SUITE 170",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923084561",
            "telephone_number": "760-961-1919",
            "fax_number": "760-961-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13692 APPLE VALLEY RD",
            "address_2": "SUITE 170",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923084561",
            "telephone_number": "760-961-1919",
            "fax_number": "760-961-1907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLE VALLEY EYEWEAR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-02",
        "last_updated": "2013-04-29",
        "status": "A",
        "authorized_official_last_name": "ETCHELLS",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "TANNER",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "760-961-1919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "CA",
            "license": "5518T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0055181",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Eyewear Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.