Provider Demographics
NPI:1568002780
Name:LUXE VISION UTAH LLC
Entity Type:Organization
Organization Name:LUXE VISION UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-698-0084
Mailing Address - Street 1:1505 W GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8109
Mailing Address - Country:US
Mailing Address - Phone:801-448-7385
Mailing Address - Fax:
Practice Address - Street 1:265 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1424
Practice Address - Country:US
Practice Address - Phone:801-448-7385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty