Provider Demographics
NPI:1477588044
Name:CLEARVUE INC
Entity Type:Organization
Organization Name:CLEARVUE INC
Other - Org Name:GRIFFETH VISION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:GRIFFETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-843-8333
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1140
Mailing Address - Country:US
Mailing Address - Phone:435-843-8333
Mailing Address - Fax:435-843-8334
Practice Address - Street 1:2376 NORTH 400 EAST
Practice Address - Street 2:BUILDING A SUITE 101
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9335
Practice Address - Country:US
Practice Address - Phone:435-843-8333
Practice Address - Fax:435-843-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3089527-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107002804102OtherSELECTHEALTH
ID59154OtherBCBS OF ID
UT1574034OtherCIGNA
UT51980339702001Medicaid
UTQM0000059932OtherALTIUS
UTTPRA07984Medicaid
UT2055676600OtherDEPT. OF LABOR
UT870672627GRIOtherEDUCATORS MUTUAL
UTTRICAREOther870672627001
UT5277420001OtherDMERC
UT51980339702001OtherBCBS OF UT
UTQM0000059932OtherALTIUS
UTTPRA07984Medicaid
UT5277420001OtherDMERC
UT1574034OtherCIGNA
UTP00022188Medicare ID - Type UnspecifiedRR MEDICARE
UT000059853Medicare PIN
UT107002804102OtherSELECTHEALTH