Provider Demographics
NPI:1376099432
Name:ION VISION PLLC
Entity Type:Organization
Organization Name:ION VISION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-791-3345
Mailing Address - Street 1:4523 N 3150 E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:UT
Mailing Address - Zip Code:84310-9779
Mailing Address - Country:US
Mailing Address - Phone:801-791-3345
Mailing Address - Fax:
Practice Address - Street 1:6191 S STATE ST STE 301
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7270
Practice Address - Country:US
Practice Address - Phone:801-268-0408
Practice Address - Fax:801-261-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7370813-9934152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTI20110616000819Medicare UPIN