Provider Demographics
NPI:1619112398
Name:EYE CARE FOR YOU LLC
Entity Type:Organization
Organization Name:EYE CARE FOR YOU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROMWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-752-6453
Mailing Address - Street 1:1300 N 200 E STE 104
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2460
Mailing Address - Country:US
Mailing Address - Phone:435-752-6453
Mailing Address - Fax:435-752-6486
Practice Address - Street 1:1300 N 200 E STE 104
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2460
Practice Address - Country:US
Practice Address - Phone:435-752-6453
Practice Address - Fax:435-752-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1109189934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000065598Medicare PIN