Provider Demographics
NPI:1407809551
Name:EYE CARE GROUP OF UTAH LC
Entity Type:Organization
Organization Name:EYE CARE GROUP OF UTAH LC
Other - Org Name:EYE FOUNDATION OF UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-268-6408
Mailing Address - Street 1:201 E 5900 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7379
Mailing Address - Country:US
Mailing Address - Phone:801-268-6408
Mailing Address - Fax:801-262-9216
Practice Address - Street 1:201 E 5900 S
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7379
Practice Address - Country:US
Practice Address - Phone:801-268-6408
Practice Address - Fax:801-262-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60698760160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty