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General NPI Number Information
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NPI Number | 1235290099
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Entity Type | Organization
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Legal Business Name | EYE SITE OF UTAH INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 307 N 300 W SUITE 302
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City | KAYSVILLE
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State | UT
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Zip | 84037-1852
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Country | US
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Telephone | 801-444-9977
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Fax |
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Provider Business Mailing Address
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Address Line | 307 N 300 W SUITE 302
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City | KAYSVILLE
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State | UT
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Zip | 84037-1852
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT ALLEN
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Credential |
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Telephone | 801-444-9977
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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 | 6257946-8908
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License Number State | UT
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