Provider Demographics
NPI:1194495739
Name:UINTA EYE AND VISION LLC
Entity type:Organization
Organization Name:UINTA EYE AND VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:CLUNY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-789-3937
Mailing Address - Street 1:547 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5302
Mailing Address - Country:US
Mailing Address - Phone:307-789-3937
Mailing Address - Fax:307-789-0797
Practice Address - Street 1:547 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5302
Practice Address - Country:US
Practice Address - Phone:307-789-3937
Practice Address - Fax:307-789-0797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty