Healthcare Provider Details

I. General information

NPI: 1740056597
Provider Name (Legal Business Name): UNITED OCULAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 S UNION PARK AVE STE 102
MIDVALE UT
84047-6705
US

IV. Provider business mailing address

7400 S UNION PARK AVE STE 102
MIDVALE UT
84047-6705
US

V. Phone/Fax

Practice location:
  • Phone: 801-797-1778
  • Fax: 801-942-1717
Mailing address:
  • Phone: 801-797-1778
  • Fax: 801-942-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LJUBISA ERNJAKOVIC
Title or Position: PRESIDENT
Credential:
Phone: 801-797-1778