Healthcare Provider Details

I. General information

NPI: 1457338709
Provider Name (Legal Business Name): VISION CARE 20/20 OF NEVADA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N MAIN
NORTH LOGAN UT
84341
US

IV. Provider business mailing address

1550 N MAIN
NORTH LOGAN UT
84341
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-3906
  • Fax: 435-753-3918
Mailing address:
  • Phone: 435-753-3906
  • Fax: 435-753-3918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1126549934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0233
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8428
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1302
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8908
License Number StateUT

VIII. Authorized Official

Name: ALBERT BRUCE BOYER
Title or Position: CEO PRESIDENT
Credential: OD
Phone: 435-753-3906