Provider Demographics
NPI:1891870002
Name:ADVANTAGE EYE CARE , P. C.
Entity type:Organization
Organization Name:ADVANTAGE EYE CARE , P. C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:801-373-1711
Mailing Address - Street 1:538 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6367
Mailing Address - Country:US
Mailing Address - Phone:801-373-1711
Mailing Address - Fax:801-373-1741
Practice Address - Street 1:538 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6367
Practice Address - Country:US
Practice Address - Phone:801-373-1711
Practice Address - Fax:801-373-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========007Medicaid
UTU000074336Medicare PIN