NPIMap

Organization Active NPI

Life Vision

  • Optometrist
  • Clearfield, UT
National Provider Identifier
1093464588
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
LIFE VISION
Practice address
Freeport Center
Building D-11
Clearfield, UT 84016
Phone
(801) 513-8933
NPI assigned
Mar 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Authorized official

Name
Mitch Pebley, OD
Title
Owner
Phone
(801) 513-8933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

Freeport Center
Building D-11
Clearfield, UT 84016

Mailing address

4138 S 3475 W
West Haven, UT 84401-8457

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1093464588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4138 S 3475 W",
            "city": "WEST HAVEN",
            "state": "UT",
            "postal_code": "844018457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FREEPORT CENTER",
            "address_2": "BUILDING D-11",
            "city": "CLEARFIELD",
            "state": "UT",
            "postal_code": "84016",
            "telephone_number": "801-513-8933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE VISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "PEBLEY",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-513-8933",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearfield, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.