Healthcare Provider Details

I. General information

NPI: 1396028510
Provider Name (Legal Business Name): WEST POINT EYE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N 2000 W SUITE F-1
WEST POINT UT
84015
US

IV. Provider business mailing address

81 NO 2000 W SUITE F-1
WEST POINT UT
84015
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-9732
  • Fax: 801-825-4333
Mailing address:
  • Phone: 801-825-9732
  • Fax: 801-825-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5345873-9934
License Number StateUT

VIII. Authorized Official

Name: DR. JUSTIN C HOLT
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 801-825-9732