MEDICARE: MOUNTAIN VALLEY EYE INSTITUTE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1891796140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VALLEY EYE INSTITUTE PC

Provider Business Mailing Address
First Line	:	2700 HOMESTEAD RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4857
Country	:	US
Telephone Number	:	435-615-0435
Fax Number	:	435-658-3094

Provider Business Practice Location Address
First Line	:	2700 HOMESTEAD RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-4857
Country	:	US
Telephone Number	:	435-658-3090
Fax Number	:	435-658-3094

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN B FASSIO
Credential	:	MD
Telephone Number	:	435-615-0435

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/21/2022

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Directions to “MOUNTAIN VALLEY EYE INSTITUTE PC ” Practice Location

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