MEDICARE: CBS VISION INC.

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1518549245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CBS VISION INC.

Provider Business Mailing Address
First Line	:	2700 HOMESTEAD RD STE 30
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4874
Country	:	US
Telephone Number	:	435-658-3090
Fax Number	:	435-658-3094

Provider Business Practice Location Address
First Line	:	2700 HOMESTEAD RD STE 30
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4874
Country	:	US
Telephone Number	:	435-658-3090
Fax Number	:	435-658-3094

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER BRYANT SMITH
Credential	:	MD
Telephone Number	:	435-658-3090

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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Directions to “CBS VISION INC. ” Practice Location

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