Provider Demographics
NPI:1659640548
Name:AVALON OCULOPLASTICS PC
Entity Type:Organization
Organization Name:AVALON OCULOPLASTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-794-4964
Mailing Address - Street 1:78 E 900 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1232
Mailing Address - Country:US
Mailing Address - Phone:801-794-4964
Mailing Address - Fax:801-798-8298
Practice Address - Street 1:78 E 900 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1232
Practice Address - Country:US
Practice Address - Phone:801-794-4964
Practice Address - Fax:801-798-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8062924-1205261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery