Provider Demographics
NPI:1396926002
Name:CLR VISION PC
Entity type:Organization
Organization Name:CLR VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIGTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-489-6066
Mailing Address - Street 1:262 EAST 400 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1956
Mailing Address - Country:US
Mailing Address - Phone:801-489-5166
Mailing Address - Fax:801-491-7694
Practice Address - Street 1:262 EAST 400 SOUTH
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1956
Practice Address - Country:US
Practice Address - Phone:801-489-5166
Practice Address - Fax:801-491-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59506608908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461538993001Medicaid
UT000058052Medicare PIN
UTV06150Medicare UPIN