1447460464 NPI number — COUNTRY HILLS EYE CENTER

Table of content: (NPI 1447460464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447460464 NPI number — COUNTRY HILLS EYE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTRY HILLS EYE CENTER
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:
1447460464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 COUNTRY HILLS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84403-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-399-1149
Provider Business Mailing Address Fax Number:
801-394-4481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 COUNTRY HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-399-1149
Provider Business Practice Location Address Fax Number:
801-394-4481
Provider Enumeration Date:
05/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STANDING
Authorized Official First Name:
SUSANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
801-388-3462

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  169112-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 186696-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 175314-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 182590-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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