| Kings Peak Vision Pllc | |
|
200 N Market Place Dr Centerville UT 84014-1752 | |
| (801) 295-7118 | |
| (801) 295-7123 |
| Full Name | Kings Peak Vision Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 N Market Place Dr, Centerville, Utah |
| Authorized Official Name and Position | Agnieszka Krol (OPTOMETRIST) |
| Authorized Official Contact | 8018952090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kings Peak Vision Pllc 869 E 4500 S Ste 270 Salt Lake City UT 84107-3049 Ph: (773) 679-1219 | Kings Peak Vision Pllc 200 N Market Place Dr Centerville UT 84014-1752 Ph: (801) 295-7118 |
| NPI Number | 1811613185 |
|---|---|
| Provider Enumeration Date | 10/18/2022 |
| Last Update Date | 12/28/2023 |
| Medicare PECOS PAC ID | 4789047432 |
|---|---|
| Medicare Enrollment ID | O20230828003018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811613185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Agnieszka Krol |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467012781 PECOS PAC ID: 1557782745 Enrollment ID: I20230828003204 |
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