Provider Demographics
NPI:1023220886
Name:OGDEN VISION CENTER
Entity Type:Organization
Organization Name:OGDEN VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-394-8885
Mailing Address - Street 1:3475 HARRISON BLVD
Mailing Address - Street 2:OGDEN VISION CENTER
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1230
Mailing Address - Country:US
Mailing Address - Phone:801-394-8885
Mailing Address - Fax:801-394-8991
Practice Address - Street 1:3475 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1230
Practice Address - Country:US
Practice Address - Phone:801-394-8885
Practice Address - Fax:801-394-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0496360001Medicare NSC