Healthcare Provider Details

I. General information

NPI: 1003949850
Provider Name (Legal Business Name): HIDDEN VALLEY EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 DRAPER PKWY STE A
DRAPER UT
84020-9096
US

IV. Provider business mailing address

1147 DRAPER PKWY
DRAPER UT
84020-9024
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-9555
  • Fax: 801-406-0444
Mailing address:
  • Phone: 801-619-9555
  • Fax: 801-406-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number97-344994-9934
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. R BRADLEY RICE
Title or Position: OWNER
Credential: O.D.
Phone: 801-619-9555