Provider Demographics
NPI:1629069281
Name:EYE SURG OF UTAH, LLC
Entity Type:Organization
Organization Name:EYE SURG OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOOPES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:801-568-0200
Mailing Address - Street 1:11820 SOUTH STATE STREET
Mailing Address - Street 2:150
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7160
Mailing Address - Country:US
Mailing Address - Phone:801-568-0200
Mailing Address - Fax:801-563-0200
Practice Address - Street 1:11820 SOUTH STATE STREET
Practice Address - Street 2:150
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7160
Practice Address - Country:US
Practice Address - Phone:801-568-0200
Practice Address - Fax:801-563-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOOPS VISION CORRECTION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-02
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2000ASF11451261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid
UT0TH000Medicare UPIN