Provider Demographics
NPI:1184809535
Name:THE EYE INSTITUTE OF UTAH
Entity type:Organization
Organization Name:THE EYE INSTITUTE OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-266-2283
Mailing Address - Street 1:755 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2105
Mailing Address - Country:US
Mailing Address - Phone:801-266-2283
Mailing Address - Fax:801-268-6151
Practice Address - Street 1:2631 FOOTHILL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4771
Practice Address - Country:US
Practice Address - Phone:307-362-4202
Practice Address - Fax:307-362-4332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EYE INSTITUTE OF UTAH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY205-13152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY108096203Medicaid