MEDICARE: EYE CENTER OF EPHRAIM, LLC

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	152W00000X	Optometrist	284643-9934	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DN6778	OTHER		RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004532	OTHER		UNITED HEALTHCARE
2	328071	OTHER	UT	ALTIUS
3	20005965601001	OTHER	UT	REGENCE BCBS - GROUP
5	107008974104	OTHER		SELECT HEALTH

General Provider Information

NPI Number	:	1457548216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CENTER OF EPHRAIM, LLC

Provider Business Mailing Address
First Line	:	43 E 450 N
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-4027
Country	:	US
Telephone Number	:	435-283-5555
Fax Number	:	435-283-8642

Provider Business Practice Location Address
First Line	:	43 E 450 N
Second Line	:
City	:	EPHRAIM
State	:	UT
Zip	:	84627-4027
Country	:	US
Telephone Number	:	435-283-5555
Fax Number	:	435-283-8642

Authorized Official
Title or Position	:	OWNER
Name	:	DARIN RAY CUMMINGS
Credential	:	O.D.
Telephone Number	:	435-283-5555

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	01/05/2009

Similar Medicare Providers

1306805007 — DARIN R. CUMMINGS O.D.
Practice Location Address:

43 E 450 N
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1780970582 — JACOB MICHAEL ROBISON O.D.
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1194415315 — CAYSON GOFF PT, DPT
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1801735576 — ELEVATE PHYSICAL THERAPY - EPHRAIM
Practice Location Address:

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84627-4027

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1174523906 — DR. CHARLES A HOWARD D.C.
Practice Location Address:

435 S MAIN ST
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1417916784 — MR. RHODRI L PURCELL PT, MPT, OCS, CSCS
Practice Location Address:

112 N MAIN ST
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Practice Fax:

Directions to “EYE CENTER OF EPHRAIM, LLC ” Practice Location

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