Provider Demographics
NPI:1215050109
Name:SOUTHERN UTAH VISION CARE, INC.
Entity type:Organization
Organization Name:SOUTHERN UTAH VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-865-9899
Mailing Address - Street 1:1251 NORTHFIELD RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8622
Mailing Address - Country:US
Mailing Address - Phone:435-865-9899
Mailing Address - Fax:
Practice Address - Street 1:1251 NORTHFIELD RD
Practice Address - Street 2:SUITE 215
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8622
Practice Address - Country:US
Practice Address - Phone:435-865-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6347896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1427140417Medicare NSC
UT000060869Medicare PIN
UTU81866Medicare UPIN