Healthcare Provider Details

I. General information

NPI: 1376832071
Provider Name (Legal Business Name): UTAH VALLEY EYE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 204
PROVO UT
84604-3374
US

IV. Provider business mailing address

1055 N 300 W STE 204
PROVO UT
84604-3374
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7777
  • Fax: 801-357-7217
Mailing address:
  • Phone: 801-357-7777
  • Fax: 801-357-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateUT

VIII. Authorized Official

Name: MR. MICHAEL CLAYTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 801-357-7373