1447340799 NPI number — WENDOVER EYE CARE, INC

Table of content: (NPI 1447340799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447340799 NPI number — WENDOVER EYE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WENDOVER EYE CARE, INC
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:
Provider Other Organization Name Type Code:
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:
1447340799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 N 300 W
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
KAYSVILLE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84037-1852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-665-7923
Provider Business Mailing Address Fax Number:
435-665-7923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
479 E WENDOVER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENDOVER
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-665-7923
Provider Business Practice Location Address Fax Number:
435-665-7923
Provider Enumeration Date:
10/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
435-665-7923

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1138799934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 62579469934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62579469902001 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com