Provider Demographics
NPI:1558650465
Name:REDROCK EYE SURGEONS P C
Entity Type:Organization
Organization Name:REDROCK EYE SURGEONS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:435-637-8689
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0261
Mailing Address - Country:US
Mailing Address - Phone:435-637-7860
Mailing Address - Fax:435-637-1123
Practice Address - Street 1:750 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-8750
Practice Address - Country:US
Practice Address - Phone:435-637-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT340176-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH11892OtherUPIN
UTU000073338Medicare PIN
COCOA105730Medicare PIN