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General NPI Number Information
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NPI Number | 1235304064
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Entity Type | Organization
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Legal Business Name | CLR VISION PC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1675 N 200 W #11A
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City | PROVO
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State | UT
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Zip | 84604-2570
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Country | US
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Telephone | 801-374-2227
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Fax | 801-374-5197
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Provider Business Mailing Address
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Address Line | 1675 N 200 W #11A
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City | PROVO
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State | UT
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Zip | 84604-2570
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Country | US
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Telephone | 801-374-2227
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Fax | 801-374-5197
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD L RIGTRUP
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Credential | OD
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Telephone | 801-374-2227
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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 | 5950660-9943
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License Number State | UT
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