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General NPI Number Information
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NPI Number | 1447460464
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Entity Type | Organization
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Legal Business Name | COUNTRY HILLS EYE CENTER
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1483 E RIDGELINE DR STE 100
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-4977
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Country | US
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Telephone | 801-399-1149
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Fax | 801-399-0248
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Provider Business Mailing Address
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Address Line | 1493 E RIDGELINE DR STE 100
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City | SOUTH OGDEN
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State | UT
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Zip | 84405-4947
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Country | US
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Telephone | 801-399-1149
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Fax | 801-394-4481
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MANDELIN BORCE
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Credential |
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Telephone | 801-399-0209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 182590-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 175314-1205
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 169112-1205
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License Number State | UT
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