Provider Demographics
NPI:1912042284
Name:REGIS OPTICAL, INC
Entity Type:Organization
Organization Name:REGIS OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGRICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-314-4410
Mailing Address - Street 1:5770 S 250 E
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8100
Mailing Address - Country:US
Mailing Address - Phone:801-314-4410
Mailing Address - Fax:
Practice Address - Street 1:5770 S 250 E
Practice Address - Street 2:SUITE 410
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-314-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870459506001Medicaid
UT870459506001Medicaid
UT0651540001Medicare NSC