Provider Demographics
NPI:1457548216
Name:EYE CENTER OF EPHRAIM, LLC
Entity Type:Organization
Organization Name:EYE CENTER OF EPHRAIM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-283-5555
Mailing Address - Street 1:43 E 450 N
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-4027
Mailing Address - Country:US
Mailing Address - Phone:435-283-5555
Mailing Address - Fax:435-283-8642
Practice Address - Street 1:43 E 450 N
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-4027
Practice Address - Country:US
Practice Address - Phone:435-283-5555
Practice Address - Fax:435-283-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284643-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2004532OtherUNITED HEALTHCARE
UT328071OtherALTIUS
UT20005965601001OtherREGENCE BCBS - GROUP
DN6778OtherRAILROAD MEDICARE PTAN
107008974104OtherSELECT HEALTH
DN6778OtherRAILROAD MEDICARE PTAN
6040860001Medicare NSC