Provider Demographics
NPI:1649460668
Name:TOTAL VISION CARE, LLC
Entity type:Organization
Organization Name:TOTAL VISION CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-302-9482
Mailing Address - Street 1:4019 W 12600 S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7401
Mailing Address - Country:US
Mailing Address - Phone:801-302-9482
Mailing Address - Fax:801-302-5532
Practice Address - Street 1:4019 W 12600 S
Practice Address - Street 2:SUITE 110
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7401
Practice Address - Country:US
Practice Address - Phone:801-302-9482
Practice Address - Fax:801-302-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5267304-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty