Provider Demographics
NPI:1013187822
Name:PROMONTORY VISION PARTNERS
Entity Type:Organization
Organization Name:PROMONTORY VISION PARTNERS
Other - Org Name:CLINTON FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-779-0708
Mailing Address - Street 1:1448 N 2000 W
Mailing Address - Street 2:#3
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8377
Mailing Address - Country:US
Mailing Address - Phone:801-779-0708
Mailing Address - Fax:
Practice Address - Street 1:1448 N 2000 W
Practice Address - Street 2:SUITE 12
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8377
Practice Address - Country:US
Practice Address - Phone:801-779-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMONTORY VISION PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5704014-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty