1023507928 NPI number — SHARON RICHENS MD EYE PHYSICIAN & SURGEON PC

Table of content: (NPI 1023507928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023507928 NPI number — SHARON RICHENS MD EYE PHYSICIAN & SURGEON PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON RICHENS MD EYE PHYSICIAN & SURGEON PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHENS EYE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023507928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 W 200 N STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-986-2020
Provider Business Mailing Address Fax Number:
435-652-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 BERTHA HOWE AVE STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89027-7503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-986-2020
Provider Business Practice Location Address Fax Number:
435-652-1516
Provider Enumeration Date:
05/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CLAYTON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
435-674-0832

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891892063 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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