Healthcare Provider Details

I. General information

NPI: 1093139438
Provider Name (Legal Business Name): KEENEYE FAMILY VISION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 W MAIN ST STE C
SANTAQUIN UT
84655-7086
US

IV. Provider business mailing address

252 W MAIN ST STE C
SANTAQUIN UT
84655-7086
US

V. Phone/Fax

Practice location:
  • Phone: 801-609-2020
  • Fax: 801-609-2015
Mailing address:
  • Phone: 801-609-2020
  • Fax: 801-609-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8897506-9934
License Number StateUT

VIII. Authorized Official

Name: DR. KENYON B ANDERSON
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 801-609-2020