Provider Demographics
NPI:1487969333
Name:OREM EYE CLINIC
Entity type:Organization
Organization Name:OREM EYE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CODNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-224-4799
Mailing Address - Street 1:209 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4745
Mailing Address - Country:US
Mailing Address - Phone:801-224-4799
Mailing Address - Fax:
Practice Address - Street 1:209 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4745
Practice Address - Country:US
Practice Address - Phone:801-224-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center