Provider Demographics
NPI:1558487975
Name:VISION HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:VISION HEALTH CENTER, INC.
Other - Org Name:VISION SOURCE AT JORDAN LANDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-566-5683
Mailing Address - Street 1:7555 CENTER VIEW CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1970
Mailing Address - Country:US
Mailing Address - Phone:801-566-5683
Mailing Address - Fax:801-255-8371
Practice Address - Street 1:7555 CENTER VIEW CT
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1970
Practice Address - Country:US
Practice Address - Phone:801-566-5683
Practice Address - Fax:801-255-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108971-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT303540236001Medicaid
UT303540236001Medicaid
UT000009646Medicare ID - Type Unspecified
UT303540236001Medicaid