Central Utah Clinic, P.C.
Organization Active NPI Eyewear Supplier · Murray, UT
NPI 1265907620 · NPPES record last updated Oct 11, 2018
Key facts
- NPI
- 1265907620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- CENTRAL UTAH CLINIC, P.C.
- Practice address
- 5872 S 900 E Ste 100
Murray, UT 84121-1677 - Phone
- (801) 261-0726
- Fax
- (801) 262-2838
- NPI assigned
- Oct 11, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTRAL UTAH CLINIC, P.C.
Authorized official
- Name
- Jed Bradley Harston
- Title
- Director of Managed Care
- Phone
- (801) 812-5012
Corporate family (same tax ID) 10
National Provider Directory
- Tax ID family
- Walstir H Fonseca MD
- Part of
- Walstir H Fonseca MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
5872 S 900 E Ste 100
Murray, UT 84121-1677
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604-3305
Phone (801) 354-8225
Other names
- Revere Health
- Optical Shop (Murray)
Other providers in Murray, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.