Healthcare Provider's Profile
| Full Name | |
|---|
| Type | Facility |
|---|
| Speciality | Eyewear Supplier |
|---|
| Location | 747 S Main St, Brigham City, Utah |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1700839545
- Provider Enumeration Date: 05/19/2006
- Last Update Date: 07/10/2008
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1700839545 | NPI | - | NPPES |
| 35524 | Other | | AVESIS |
| 17927 | Other | | MEDICARE |
| 410985054-165 | Medicaid | UT | |
| CP2230-41 | Other | | EYEMED |
| 014104 | Other | | VIP |
| UT04883 | Other | UT | NORIDIAN SUBMITTER ID |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 156FX1800X | Technician/technologist - Optician | (* (Not Available)) | Secondary |
| 332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
747 S Main St,
Brigham City, UT 84302-3359
Ph: (435) 723-1800 |
747 S Main St,
Brigham City, UT 84302-3359
Ph: (435) 723-1800 |
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