Provider Demographics
NPI:1710183850
Name:ACKERSON EYECARE INC.
Entity Type:Organization
Organization Name:ACKERSON EYECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAWES
Authorized Official - Last Name:ACKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-657-1212
Mailing Address - Street 1:736 W 100 S
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3739
Mailing Address - Country:US
Mailing Address - Phone:435-657-1212
Mailing Address - Fax:435-657-9522
Practice Address - Street 1:736 W 100 S
Practice Address - Street 2:SUITE #2
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3739
Practice Address - Country:US
Practice Address - Phone:435-657-1212
Practice Address - Fax:435-657-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4764729-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4182180001Medicare NSC