Provider Demographics
NPI:1518117407
Name:RETINA AND VITREOUS SURGEONS OF UTAH, LLC
Entity Type:Organization
Organization Name:RETINA AND VITREOUS SURGEONS OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-357-7704
Mailing Address - Street 1:1055 N 300 W STE 500
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3312
Mailing Address - Country:US
Mailing Address - Phone:801-357-7704
Mailing Address - Fax:801-357-7424
Practice Address - Street 1:1055 N 300 W STE 500
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3312
Practice Address - Country:US
Practice Address - Phone:801-357-7704
Practice Address - Fax:801-357-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty