=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407060072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN VIEW EYE CENTER PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 05/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3988 WASHINGTON BLVD
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-1826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-621-2883
-----------------------------------------------------
Fax | 801-334-7930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3988 WASHINGTON BLVD
-----------------------------------------------------
City | OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84403-1826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-621-2883
-----------------------------------------------------
Fax | 801-334-7930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANSLEY ALLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-773-2233
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------