Provider Demographics
NPI:1689997165
Name:DAVIS VISION CENTER ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DAVIS VISION CENTER ASSOCIATES PLLC
Other - Org Name:DAVIS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-253-3080
Mailing Address - Street 1:11649 SOUTH 4000 WEST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-9060
Mailing Address - Country:US
Mailing Address - Phone:201-253-3080
Mailing Address - Fax:801-253-0772
Practice Address - Street 1:1325 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9060
Practice Address - Country:US
Practice Address - Phone:801-253-3080
Practice Address - Fax:801-253-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT172302-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6359480001Medicare NSC
UT000066115Medicare PIN