Provider Demographics
NPI:1063619740
Name:HEALTHY EYES ASSOCIATES LLC
Entity type:Organization
Organization Name:HEALTHY EYES ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-578-2020
Mailing Address - Street 1:8806 REDWOOD RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9337
Mailing Address - Country:US
Mailing Address - Phone:801-578-2020
Mailing Address - Fax:801-748-4892
Practice Address - Street 1:8806 REDWOOD RD
Practice Address - Street 2:STE. 101
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9337
Practice Address - Country:US
Practice Address - Phone:801-578-2020
Practice Address - Fax:801-748-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59229269934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV05478Medicare UPIN