1356400337 NPI number — APPLE VALLEY VISION LLC

Table of content: (NPI 1356400337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356400337 NPI number — APPLE VALLEY VISION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APPLE VALLEY VISION LLC
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:
1356400337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
539 SOUTH 100 WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-465-0355
Provider Business Mailing Address Fax Number:
801-465-9238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 SOUTH 100 WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-465-0355
Provider Business Practice Location Address Fax Number:
801-465-9238
Provider Enumeration Date:
12/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROWLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
FARNSWORTH
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
801-465-0355

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  51471439934 , 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: 5147143-9934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 51471439934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: 5147143-9934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 51471439934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: 51471439934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 51471439934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: 51471439934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: 5147143-9934 , 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)

  • Identifier: U67146 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529516546001 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".