Provider Demographics
NPI:1962961086
Name:CORPORATE CONCIERGE
Entity type:Organization
Organization Name:CORPORATE CONCIERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-667-8933
Mailing Address - Street 1:2150 W ASPEN WOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4040
Mailing Address - Country:US
Mailing Address - Phone:517-667-8933
Mailing Address - Fax:
Practice Address - Street 1:4415 N DEER RIDGE TRAIL
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043
Practice Address - Country:US
Practice Address - Phone:517-667-8933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1790210011Medicaid