Provider Demographics
NPI:1205381860
Name:OPTOMETRIX
Entity Type:Organization
Organization Name:OPTOMETRIX
Other - Org Name:MAGNIFY EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-910-3957
Mailing Address - Street 1:175 W CANYON CREST RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-2010
Mailing Address - Country:US
Mailing Address - Phone:801-910-3957
Mailing Address - Fax:
Practice Address - Street 1:175 W CANYON CREST RD
Practice Address - Street 2:SUITE 305
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-2010
Practice Address - Country:US
Practice Address - Phone:801-910-3957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90422859934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty