Provider Demographics
NPI:1699015214
Name:SALT LAKE EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SALT LAKE EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:BENATOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-281-2020
Mailing Address - Street 1:1025 E 3300 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4389
Mailing Address - Country:US
Mailing Address - Phone:801-281-2020
Mailing Address - Fax:801-487-3689
Practice Address - Street 1:1025 E 3300 S
Practice Address - Street 2:SUITE B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4389
Practice Address - Country:US
Practice Address - Phone:801-281-2020
Practice Address - Fax:801-487-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT177470-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1518298678OtherNPI
UT1053316976OtherNPI
UT1093822561OtherNPI
UT1093822561OtherNPI