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General NPI Number Information
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NPI Number | 1528186954
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Entity Type | Organization
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Legal Business Name | RETINA AND VITREOUS SURGEONS OF UTAH INC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 1055 N 300 W SUITE 210
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City | PROVO
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State | UT
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Zip | 84604-3344
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Country | US
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Telephone | 801-357-7704
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Fax | 801-357-7424
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Provider Business Mailing Address
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Address Line | 1055 N 300 W SUITE 210
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City | PROVO
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State | UT
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Zip | 84604-3344
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Country | US
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Telephone | 801-357-7704
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Fax | 801-357-7424
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Authorized Official
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Title or Position | PRESIDENT OR CEO
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Name | JOHN ALAN CARVER
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Credential | MD
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Telephone | 801-357-7704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 165213-1205
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License Number State | UT
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