Provider Demographics
NPI:1407516495
Name:THE EYE DOCTOR & OPTICAL
Entity Type:Organization
Organization Name:THE EYE DOCTOR & OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-360-3371
Mailing Address - Street 1:PO BOX 970490
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-0490
Mailing Address - Country:US
Mailing Address - Phone:801-210-9339
Mailing Address - Fax:801-960-2887
Practice Address - Street 1:574 W 1600 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2556
Practice Address - Country:US
Practice Address - Phone:801-210-9339
Practice Address - Fax:801-960-2887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty