1831585330 NPI number — LOGAN EYE INSTITUTE, PLLC

Table of content: (NPI 1831585330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831585330 NPI number — LOGAN EYE INSTITUTE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOGAN EYE INSTITUTE, PLLC
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:
MONSON VISION
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:
1831585330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 S 100 W
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOGAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84321-5929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-787-7200
Provider Business Mailing Address Fax Number:
435-787-7203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 S 100 W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84321-5929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-787-7200
Provider Business Practice Location Address Fax Number:
435-787-7203
Provider Enumeration Date:
04/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MONSON
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
435-787-7200

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , 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: 1639256670 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1902829799 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1407885007 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1689603284 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1932321460 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1699742684 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com