Provider Demographics
NPI:1952623712
Name:COTTONWOOD EYE AND LASER CENTER
Entity Type:Organization
Organization Name:COTTONWOOD EYE AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-6600
Mailing Address - Street 1:201 E. 5900 S.
Mailing Address - Street 2:STE 101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5428
Mailing Address - Country:US
Mailing Address - Phone:801-268-6600
Mailing Address - Fax:801-268-6602
Practice Address - Street 1:201 E. 5900 S.
Practice Address - Street 2:STE 101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5428
Practice Address - Country:US
Practice Address - Phone:801-268-6600
Practice Address - Fax:801-268-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75845890160207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty