Provider Demographics
NPI:1750791943
Name:EAGLE VISION
Entity type:Organization
Organization Name:EAGLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-725-8630
Mailing Address - Street 1:4408 E PONY EXPRESS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5564
Mailing Address - Country:US
Mailing Address - Phone:801-789-3937
Mailing Address - Fax:801-228-2420
Practice Address - Street 1:4408 E PONY EXPRESS PKWY STE A
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5564
Practice Address - Country:US
Practice Address - Phone:801-789-3937
Practice Address - Fax:801-228-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6621539-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000086776OtherPTAN