Healthcare Provider Details

I. General information

NPI: 1669978896
Provider Name (Legal Business Name): SOUTHERN UTAH VISION CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NORTHFIELD RD STE 215
CEDAR CITY UT
84721-8623
US

IV. Provider business mailing address

1251 NORTHFIELD RD STE 215
CEDAR CITY UT
84721-8623
US

V. Phone/Fax

Practice location:
  • Phone: 435-865-7902
  • Fax:
Mailing address:
  • Phone: 435-865-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM SCOTT ALBRECHT
Title or Position: OWNER
Credential: OD
Phone: 435-865-7902