Provider Demographics
NPI:1518149905
Name:KANE COUNTY EYE CARE INC.
Entity Type:Organization
Organization Name:KANE COUNTY EYE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-644-5717
Mailing Address - Street 1:75 E 200 S STE 1
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3606
Mailing Address - Country:US
Mailing Address - Phone:435-644-5717
Mailing Address - Fax:435-644-5790
Practice Address - Street 1:75 E 200 S STE 1
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3606
Practice Address - Country:US
Practice Address - Phone:435-644-5717
Practice Address - Fax:435-644-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3755239934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4764020001Medicare NSC