| |
550 E 1400 N Ste T, Logan, UT 84341-2407 | |
(435) 752-2020 | |
(435) 752-5475 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 550 E 1400 N Ste T, Logan, Utah |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225330673 | NPI | - | NPPES |
1932321460 | Medicaid | UT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 8127835-9934 (Utah) | Secondary |
332H00000X | Eyewear Supplier | 6962612-1205 (Utah) | Primary |
Mailing Address | Practice Location Address |
---|---|
550 E 1400 N Ste T, Logan, UT 84341-2407 Ph: (435) 752-2020 | 550 E 1400 N Ste T, Logan, UT 84341-2407 Ph: (435) 752-2020 |