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General NPI Number Information
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NPI Number | 1568002780
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Entity Type | Organization
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Legal Business Name | LUXE VISION UTAH LLC
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 265 N MAIN ST STE D
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City | KAYSVILLE
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State | UT
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Zip | 84037-1424
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Country | US
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Telephone | 801-448-7385
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 W GRANITE DR
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City | LAYTON
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State | UT
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Zip | 84041-8109
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Country | US
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Telephone | 801-448-7385
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MATT HAUCK
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Credential |
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Telephone | 801-698-0084
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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 |
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License Number State |
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