Provider Demographics
NPI:1760258552
Name:VINEYARD EYE CARE LLC
Entity Type:Organization
Organization Name:VINEYARD EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAXTON
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:HAWKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MBA
Authorized Official - Phone:801-717-5655
Mailing Address - Street 1:691 E 400 N STE 220
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-7510
Mailing Address - Country:US
Mailing Address - Phone:801-754-6955
Mailing Address - Fax:801-436-3710
Practice Address - Street 1:691 E 400 N STE 220
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-7510
Practice Address - Country:US
Practice Address - Phone:801-717-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty