Provider Demographics
NPI:1770754145
Name:HURRICANE VALLEY EYE CARE PC
Entity type:Organization
Organization Name:HURRICANE VALLEY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:DORIUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-635-7766
Mailing Address - Street 1:20 S 850 W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3214
Mailing Address - Country:US
Mailing Address - Phone:435-635-7766
Mailing Address - Fax:435-635-9128
Practice Address - Street 1:20 S 850 W
Practice Address - Street 2:SUITE 3
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3214
Practice Address - Country:US
Practice Address - Phone:435-635-7766
Practice Address - Fax:435-635-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5343436-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519962929003Medicaid
UT519962929003Medicaid
UT000057760Medicare PIN