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General NPI Number Information
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NPI Number | 1063619740
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Entity Type | Organization
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Legal Business Name | HEALTHY EYES ASSOCIATES LLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 8806 REDWOOD RD STE. 101
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City | WEST JORDAN
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State | UT
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Zip | 84088-9337
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Country | US
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Telephone | 801-578-2020
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Fax | 801-748-4892
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Provider Business Mailing Address
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Address Line | 8806 REDWOOD RD STE. 101
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City | WEST JORDAN
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State | UT
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Zip | 84088-9337
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Country | US
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Telephone | 801-578-2020
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Fax | 801-748-4892
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JORY T KIMBALL
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Credential | O.D.
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Telephone | 801-578-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 59229269934
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License Number State | UT
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