Provider Demographics
NPI:1225242894
Name:ANDRUS VISION CENTER PC
Entity Type:Organization
Organization Name:ANDRUS VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-4464
Mailing Address - Street 1:803 S BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5202
Mailing Address - Country:US
Mailing Address - Phone:435-628-4464
Mailing Address - Fax:435-628-5015
Practice Address - Street 1:803 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5202
Practice Address - Country:US
Practice Address - Phone:435-628-4464
Practice Address - Fax:435-628-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108815-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4308150001Medicare NSC