Provider Demographics
NPI:1427248467
Name:ADVANCED EYE CARE INC
Entity type:Organization
Organization Name:ADVANCED EYE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PLOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-263-2020
Mailing Address - Street 1:1250 E 3900 S STE 310
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1350
Mailing Address - Country:US
Mailing Address - Phone:801-263-2020
Mailing Address - Fax:801-263-2229
Practice Address - Street 1:1250 E 3900 S STE 310
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1350
Practice Address - Country:US
Practice Address - Phone:801-263-2020
Practice Address - Fax:801-263-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X, 207W00000X
UT150237-1205302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT061606139002Medicaid
UT529680524003Medicaid
UT061606139002Medicaid
UT529680524003Medicaid