Provider Demographics
NPI:1659917706
Name:PROGRESSIVE EYE CARE, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROADHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-676-2020
Mailing Address - Street 1:192 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2628
Mailing Address - Country:US
Mailing Address - Phone:801-261-2020
Mailing Address - Fax:
Practice Address - Street 1:192 E 4500 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2628
Practice Address - Country:US
Practice Address - Phone:801-261-2020
Practice Address - Fax:801-261-2052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE EYE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty