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General NPI Number Information
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NPI Number | 1164613790
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Entity Type | Organization
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Legal Business Name | CATARACT & LASIK CENTER OF UTAH PC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 1972 W GROVE PKWY STE 200
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6729
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Country | US
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Telephone | 801-224-6767
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Fax | 801-221-1052
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Provider Business Mailing Address
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Address Line | 1972 W GROVE PKWY STE 200
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-6729
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Country | US
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Telephone | 801-224-6767
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Fax | 801-221-1052
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Authorized Official
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Title or Position | DIRECTOR/SURGEON
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Name | JAMIE M MONROE
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Credential | MD
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Telephone | 801-224-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 2619191205
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License Number State | UT
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