Healthcare Provider Details

I. General information

NPI: 1285803361
Provider Name (Legal Business Name): ROY VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4896 S 1900 W
ROY UT
84067-2994
US

IV. Provider business mailing address

4896 S 1900 W
ROY UT
84067-2994
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-2999
  • Fax: 801-773-4221
Mailing address:
  • Phone: 801-773-2999
  • Fax: 801-773-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. STACY L. RENCHER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 801-773-2999