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NPI Code Detail

MEDICARE: LUXE VISION UTAH LLC

MEDICARE: LUXE VISION UTAH 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1568002780
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUXE VISION UTAH LLC
Provider Business Mailing Address
First Line : 1505 W GRANITE DR
Second Line :
City : LAYTON
State : UT
Zip : 84041-8109
Country : US
Telephone Number : 801-448-7385
Fax Number :
Provider Business Practice Location Address
First Line : 265 N MAIN ST STE D
Second Line :
City : KAYSVILLE
State : UT
Zip : 84037-1424
Country : US
Telephone Number : 801-448-7385
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MATT HAUCK
Credential :
Telephone Number : 801-698-0084
Provider Enumeration Date : 01/15/2020
Last Update Date : 04/27/2023

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Directions to “LUXE VISION UTAH LLC ” Practice Location

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