Provider Demographics
NPI:1841421914
Name:MOUNT OGDEN EYE CENTER
Entity Type:Organization
Organization Name:MOUNT OGDEN EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:APADACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-529-2483
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6529
Mailing Address - Country:US
Mailing Address - Phone:801-593-9223
Mailing Address - Fax:801-593-9626
Practice Address - Street 1:520 MEDICAL DR
Practice Address - Street 2:STE 201
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4968
Practice Address - Country:US
Practice Address - Phone:801-292-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7143320-1205261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery