MEDICARE: CLEAR VIEW EYE CARE P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	6300367-9934	UT
2	152WP0200X	Pediatric Optometrist	6300367-9934	UT
3	152WV0400X	Vision Therapy Optometrist	6300367-9934	UT
4	152W00000X	Optometrist	6300367-9934	UT

General Provider Information

NPI Number	:	1033301239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR VIEW EYE CARE P.C.

Provider Business Mailing Address
First Line	:	1100 CANYON VIEW DR STE G
Second Line	:
City	:	SANTA CLARA
State	:	UT
Zip	:	84765-5672
Country	:	US
Telephone Number	:	435-674-3502
Fax Number	:	435-674-0227

Provider Business Practice Location Address
First Line	:	1100 CANYON VIEW DR STE G
Second Line	:
City	:	SANTA CLARA
State	:	UT
Zip	:	84765-5672
Country	:	US
Telephone Number	:	435-674-3502
Fax Number	:	435-674-0227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHAUNE WALLACE
Credential	:	O.D.
Telephone Number	:	435-674-3502

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	06/15/2011

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Directions to “CLEAR VIEW EYE CARE P.C. ” Practice Location

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