Provider Demographics
NPI:1366515041
Name:EYE INSTITUTE OF UTAH INC
Entity type:Organization
Organization Name:EYE INSTITUTE OF UTAH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-5715
Mailing Address - Street 1:755 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2105
Mailing Address - Country:US
Mailing Address - Phone:801-266-2283
Mailing Address - Fax:801-268-6151
Practice Address - Street 1:755 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2105
Practice Address - Country:US
Practice Address - Phone:801-266-2283
Practice Address - Fax:801-268-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCE7279OtherRAILROAD MEDICARE
UT000055045Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WYW4510007Medicare PIN