Provider Demographics
NPI:1255570354
Name:EYEMAX EYECARE, PLLC.
Entity type:Organization
Organization Name:EYEMAX EYECARE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZANIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEHDARI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-674-8802
Mailing Address - Street 1:166 E 5900 S STE B103
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7278
Mailing Address - Country:US
Mailing Address - Phone:801-674-8802
Mailing Address - Fax:
Practice Address - Street 1:166 E 5900 S STE B103
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7278
Practice Address - Country:US
Practice Address - Phone:801-674-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDQ8463OtherRAILROAD MEDICARE