Eyre Dermatology Clinic, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

1088470-0144 Issued in UT

Legal business name

EYRE DERMATOLOGY CLINIC, P.C.

Practice address

486 W 800 N
Suite 201
Orem, UT 84057-3728

Phone

(801) 431-0300

Fax

(801) 431-0312

NPI assigned

Jul 13, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Russell Warren Eyre, M.D.NPI 1851395529

Title

President

Phone

(801) 431-0300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Russell Warren Eyre, M.D.

  • Dermatopathology Physician
  • Orem, UT
  • NPI 1851395529
  Medicare reassignment Care Compare group NPD Authorized official
• Steven Paul Eyre, M.D.

  • Procedural Dermatology Physician
  • Orem, UT
  • NPI 1174520597
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013915867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 W 800 N",
            "address_2": "SUITE 201",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573728",
            "telephone_number": "801-431-0300",
            "fax_number": "801-431-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 W 800 N",
            "address_2": "SUITE 201",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573728",
            "telephone_number": "801-431-0300",
            "fax_number": "801-431-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYRE DERMATOLOGY CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EYRE",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-431-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": "1088470-0144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Experience Mental Wellness LLC
• Express Medical Technology L.L.C.
• Eye Physicians of Utah
• Eye Pros of Orem
• Eyemart Express LLC
• Russell Warren Eyre, M.D.
• Scott Eyre
• Steven Paul Eyre, M.D.
• Brandon Faalafua
• Jill Bateman Faatz, M.D.

• Specialist in Orem, UT
• Providers in Orem, UT by specialty
• Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.