Provider Demographics
NPI:1609921741
Name:BRWEYE INC
Entity Type:Organization
Organization Name:BRWEYE INC
Other - Org Name:INVISION EYE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORD.
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-664-7131
Mailing Address - Street 1:10385 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0964
Mailing Address - Country:US
Mailing Address - Phone:801-495-2020
Mailing Address - Fax:801-984-5665
Practice Address - Street 1:10385 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0964
Practice Address - Country:US
Practice Address - Phone:801-495-2020
Practice Address - Fax:801-984-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528904174108Medicaid
UT000057081Medicare PIN
UT528904174108Medicaid