Apple Valley Vision LLC – Optometrist in Payson, UT

Key facts

NPI: 1356400337
Entity type: Organization (NPI type 2)
Primary specialty: Optometrist 152W00000X
License: 5147143-9934 (UT)
Legal business name: APPLE VALLEY VISION LLC
Practice address: 539 South 100 West
Payson, UT 84651
Phone: (801) 465-0355
Fax: (801) 465-9238
NPI assigned: Dec 6, 2006
Organization subpart: No

Authorized official

Name: Brian Farnsworth Rowley, O.D. NPI 1588771414
Title: Physician
Phone: (801) 465-0355

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 4

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

Brian Farnsworth Rowley, O.D. Optometrist · Payson, UT · NPI 1588771414

Medicare reassignment NPD Authorized official OPTOMETRIST · UT
Jordan Spencer Ericksen, OD Optometrist · Payson, UT · NPI 1598557753

NPD OPTOMETRIST
Richard James Houghton, O.D. Optometrist · Highland, UT · NPI 1336241926

NPD (past) OPTOMETRIST
Marc L Braithwaite, O.D. Optometrist · Auburn, MA · NPI 1780641357

NPD (past) OPTOMETRIST

Medicare participation

Medicare fee-for-service enrollment: Enrolled in UT

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040526001433	UT	Part B Supplier - Clinic/Group Practice	7416938311	Receives reassigned benefits from 1 practitioner Practice locations: Payson, UT

National Provider Directory

Locations

539 S 100 W
Payson, UT 84651
Phone (801) 455-0355

675 S 100 W
Ste 3
Payson, UT 84651
Phone (385) 219-7642

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152W00000X	51471439934	UT
Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152W00000X	5147143-9934	UT	Yes
Corneal and Contact Management Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WC0802X	51471439934	UT
Low Vision Rehabilitation Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WL0500X	5147143-9934	UT
Pediatric Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WP0200X	51471439934	UT
Sports Vision Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WS0006X	51471439934	UT
Vision Therapy Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WV0400X	51471439934	UT
Occupational Vision Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WX0102X	51471439934	UT
Occupational Vision Optometrist Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	152WX0102X	5147143-9934	UT

Addresses

Primary practice location

539 South 100 West
Payson, UT 84651

Mailing address

539 South 100 West
Payson, UT 84651
Phone (801) 465-0355

Other identifiers

Identifier	Type	State	Issuer
U67146	Medicaid	UT
529516546001	Medicaid	UT

Other providers in Payson, UT

All providers in Payson, UT · Optometrist in Utah

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.