Provider Demographics
NPI:1598303075
Name:CHOICE EYE CENTER, LLC
Entity Type:Organization
Organization Name:CHOICE EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-987-8698
Mailing Address - Street 1:12272 S 800 E STE 100A
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9776
Mailing Address - Country:US
Mailing Address - Phone:801-987-8698
Mailing Address - Fax:801-206-3449
Practice Address - Street 1:12272 S 800 E STE 100A
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9776
Practice Address - Country:US
Practice Address - Phone:801-987-8698
Practice Address - Fax:801-206-3449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty