Provider Demographics
NPI:1801198247
Name:MOUNTAIN VIEW FAMILY EYECARE PLLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TORY
Authorized Official - Middle Name:JUSTINE
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-657-1555
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0511
Mailing Address - Country:US
Mailing Address - Phone:435-657-1555
Mailing Address - Fax:435-657-1556
Practice Address - Street 1:425 E 1200 S
Practice Address - Street 2:STE 200
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3943
Practice Address - Country:US
Practice Address - Phone:435-657-1555
Practice Address - Fax:435-657-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7671967-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty