Provider Demographics
NPI:1144395203
Name:APPLE CONTACT LENS CENTER INC.
Entity Type:Organization
Organization Name:APPLE CONTACT LENS CENTER INC.
Other - Org Name:APPLE VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-561-5124
Mailing Address - Street 1:901 E 9400 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3671
Mailing Address - Country:US
Mailing Address - Phone:801-561-5124
Mailing Address - Fax:801-561-5732
Practice Address - Street 1:901 E 9400 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3671
Practice Address - Country:US
Practice Address - Phone:801-561-5124
Practice Address - Fax:801-561-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT921111919934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT381487205010Medicaid
UT381487505037Medicaid
UT381487505023Medicaid
UTU65943Medicare UPIN