Provider Demographics
NPI:1104123801
Name:UTAH VISION DEVELOPMENT CENTER, LLC
Entity type:Organization
Organization Name:UTAH VISION DEVELOPMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-810-1060
Mailing Address - Street 1:3672 W SOUTH JORDAN PKWY
Mailing Address - Street 2:STE 103
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-7171
Mailing Address - Country:US
Mailing Address - Phone:801-810-1060
Mailing Address - Fax:
Practice Address - Street 1:3672 W SOUTH JORDAN PKWY
Practice Address - Street 2:STE 103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-7171
Practice Address - Country:US
Practice Address - Phone:801-810-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7383319-9934152WS0006X, 152WV0400X, 152W00000X, 152WV0400X
UT6234805-9934152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty