Healthcare Provider Details

I. General information

NPI: 1104798735
Provider Name (Legal Business Name): CEDAR VALLEY EYECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 N PONY EXPRESS PKWY
EAGLE MOUNTAIN UT
84005-1230
US

IV. Provider business mailing address

4317 N PONY EXPRESS PKWY
EAGLE MOUNTAIN UT
84005-1230
US

V. Phone/Fax

Practice location:
  • Phone: 801-768-4100
  • Fax: 801-768-0600
Mailing address:
  • Phone: 801-768-4100
  • Fax: 801-768-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. COLLIN GRAY
Title or Position: OPTOMETRIST
Credential: OD
Phone: 801-473-5127