Provider Demographics
NPI:1215947023
Name:DAVIS VISION CENTER
Entity type:Organization
Organization Name:DAVIS VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-253-3080
Mailing Address - Street 1:1325 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9060
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:1325 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9060
Practice Address - Country:US
Practice Address - Phone:801-253-3080
Practice Address - Fax:801-253-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT180043150OtherRAILROAD MEDICARE
UTDH0042OtherRRMD GROUP
UT1679583470Medicaid
UTDH0042OtherRRMD GROUP
UTF56431Medicare UPIN
UT4867550001Medicare NSC