Provider Demographics
NPI:1285678565
Name:NEBO VISION INC.
Entity Type:Organization
Organization Name:NEBO VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:PEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-632-2100
Mailing Address - Street 1:48 S MAIN ST
Mailing Address - Street 2:PO BOX 196
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648-1708
Mailing Address - Country:US
Mailing Address - Phone:435-623-2100
Mailing Address - Fax:435-623-1671
Practice Address - Street 1:48 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1708
Practice Address - Country:US
Practice Address - Phone:435-623-2100
Practice Address - Fax:435-623-1671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870496971002Medicaid
UT000057077Medicare PIN
UT4581090001Medicare NSC