Provider Demographics
NPI:1407060072
Name:MOUNTAIN VIEW EYE CENTER
Entity Type:Organization
Organization Name:MOUNTAIN VIEW EYE CENTER
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-773-2233
Mailing Address - Street 1:3988 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1826
Mailing Address - Country:US
Mailing Address - Phone:801-621-2883
Mailing Address - Fax:801-334-7930
Practice Address - Street 1:3988 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1826
Practice Address - Country:US
Practice Address - Phone:801-621-2883
Practice Address - Fax:801-334-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
UT111436-9934152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528923436008Medicaid
UTT78138Medicare UPIN
UT000009464Medicare PIN
UT0543760001Medicare NSC
UT410002727Medicare PIN
UT528923436008Medicaid