Provider Demographics
NPI:1376971853
Name:MIND 1ST USA LLC
Entity Type:Organization
Organization Name:MIND 1ST USA LLC
Other - Org Name:OGDEN EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-803-6434
Mailing Address - Street 1:2507 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2500
Mailing Address - Country:US
Mailing Address - Phone:801-803-6434
Mailing Address - Fax:801-807-8003
Practice Address - Street 1:2507 MADISON AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2500
Practice Address - Country:US
Practice Address - Phone:801-803-6434
Practice Address - Fax:801-807-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty