Provider Demographics
NPI:1649245333
Name:ESPLIN EYE CENTER LLC
Entity type:Organization
Organization Name:ESPLIN EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-794-3937
Mailing Address - Street 1:59 S 400 W
Mailing Address - Street 2:PO BOX 267
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1802
Mailing Address - Country:US
Mailing Address - Phone:801-794-3937
Mailing Address - Fax:801-794-9880
Practice Address - Street 1:59 S 400 W
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2053
Practice Address - Country:US
Practice Address - Phone:801-794-3937
Practice Address - Fax:801-794-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56790148908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528835513Medicaid
UT005800201Medicare ID - Type Unspecified
UT528835513Medicaid