Provider Demographics
NPI:1245558519
Name:EYECARE WELLNESS CLINIC P.L.L.C.
Entity type:Organization
Organization Name:EYECARE WELLNESS CLINIC P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BOYLE
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-309-4832
Mailing Address - Street 1:174 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3625
Mailing Address - Country:US
Mailing Address - Phone:801-627-9868
Mailing Address - Fax:801-627-9870
Practice Address - Street 1:4848 S 900 W
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3726
Practice Address - Country:US
Practice Address - Phone:801-627-9868
Practice Address - Fax:801-627-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5676092-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty