Healthcare Provider Details

I. General information

NPI: 1578949699
Provider Name (Legal Business Name): DUVAL EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W. RIVER PARK DRIVE STE.245
PROVO UT
84604-6065
US

IV. Provider business mailing address

320 W. RIVER PARK DRIVE STE.245
PROVO UT
84604-6065
US

V. Phone/Fax

Practice location:
  • Phone: 801-800-8508
  • Fax: 801-341-0266
Mailing address:
  • Phone: 801-800-8508
  • Fax: 801-341-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DEVIN ACEL DUVAL
Title or Position: PRESIDENT
Credential: OD
Phone: 801-800-8508