Provider Demographics
NPI:1427873553
Name:AMERICAN FORK VISION LLC
Entity type:Organization
Organization Name:AMERICAN FORK VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SKYLER
Authorized Official - Middle Name:ALGER
Authorized Official - Last Name:PAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-673-4090
Mailing Address - Street 1:24 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2318
Practice Address - Country:US
Practice Address - Phone:801-756-7996
Practice Address - Fax:801-756-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty