Provider Demographics
NPI:1760545735
Name:UTAH VALLEY OPTOMETRIC PHYSICIANS
Entity Type:Organization
Organization Name:UTAH VALLEY OPTOMETRIC PHYSICIANS
Other - Org Name:DRS. CAYWOOD & WINWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAER
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-489-5111
Mailing Address - Street 1:374 E 400 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1974
Mailing Address - Country:US
Mailing Address - Phone:801-489-5111
Mailing Address - Fax:801-489-8957
Practice Address - Street 1:374 E 400 S
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1974
Practice Address - Country:US
Practice Address - Phone:801-489-5111
Practice Address - Fax:801-489-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA7215OtherRAILROAD MEDICARE
DB9393OtherRAILROAD MEDICARE
5064980001Medicare NSC
UT000057501Medicare ID - Type UnspecifiedPROVO BILLING GROUP
DB9393OtherRAILROAD MEDICARE