Healthcare Provider Details

I. General information

NPI: 1336294750
Provider Name (Legal Business Name): EYE CARE FOR KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 S STATE ST
MIDVALE UT
84047-1239
US

IV. Provider business mailing address

6911 S STATE ST
MIDVALE UT
84047-1239
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-8525
  • Fax: 801-255-8526
Mailing address:
  • Phone: 801-255-8525
  • Fax: 801-255-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH G. CARBONE
Title or Position: EXECUTIVE DIRECTOR
Credential: ABOC, NCLC
Phone: 801-255-8525