Provider Demographics
NPI:1477736403
Name:SOUTHEASTERN UTAH EYE CLINIC PC
Entity Type:Organization
Organization Name:SOUTHEASTERN UTAH EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT STOCK HOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:OLSON
Authorized Official - Last Name:SACCOMANNO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-637-2414
Mailing Address - Street 1:54 E 100 N
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501
Mailing Address - Country:US
Mailing Address - Phone:435-637-2414
Mailing Address - Fax:435-637-8205
Practice Address - Street 1:54 E 100 N
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501
Practice Address - Country:US
Practice Address - Phone:435-637-2414
Practice Address - Fax:435-637-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60582630144152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty