Provider Demographics
NPI:1447432158
Name:SOUTHERN UTAH EYE PHYSICIANS
Entity Type:Organization
Organization Name:SOUTHERN UTAH EYE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-2020
Mailing Address - Street 1:1791 E 280 N
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2400
Mailing Address - Country:US
Mailing Address - Phone:435-656-2020
Mailing Address - Fax:435-673-4131
Practice Address - Street 1:1791 E 280 N
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2400
Practice Address - Country:US
Practice Address - Phone:435-656-2020
Practice Address - Fax:435-673-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1880291205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT639146817057Medicaid
UT071588111011Medicaid
F36695Medicare UPIN
UT071588111011Medicaid