Healthcare Provider Details

I. General information

NPI: 1063619740
Provider Name (Legal Business Name): HEALTHY EYES ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8806 REDWOOD RD STE. 101
WEST JORDAN UT
84088-9337
US

IV. Provider business mailing address

8806 REDWOOD RD STE. 101
WEST JORDAN UT
84088-9337
US

V. Phone/Fax

Practice location:
  • Phone: 801-578-2020
  • Fax: 801-748-4892
Mailing address:
  • Phone: 801-578-2020
  • Fax: 801-748-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number59229269934
License Number StateUT

VIII. Authorized Official

Name: DR. JORY T KIMBALL
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 801-578-2020