Healthcare Provider Details

I. General information

NPI: 1881801504
Provider Name (Legal Business Name): EASTERN UTAH EYE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N FAIRGROUNDS RD SUITE 2
PRICE UT
84501-4205
US

IV. Provider business mailing address

200 N FAIRGROUNDS RD SUITE 2
PRICE UT
84501-4205
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-8689
  • Fax: 435-637-1123
Mailing address:
  • Phone: 435-637-8689
  • Fax: 435-637-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number289301-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number289301-1205
License Number StateUT

VIII. Authorized Official

Name: LYNELLE HANSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-637-8689