Eye Doctor LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

EYE DOCTOR LLC

Practice address

5331 Adams Ave Pkwy Ste B
Ogden, UT 84405-4755

Phone

(801) 479-7850

Fax

(801) 479-7825

NPI assigned

May 29, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Jeremiah V Church, OD

Title

Optometrist

Phone

(801) 479-7850

Specialties & licenses 2

Addresses

Other names 1

• Promontory Family Vision Doing business as

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590710400000",
    "number": "1407470040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11187 S 2865 W",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958438",
            "telephone_number": "801-910-6063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 ADAMS AVE PKWY STE B",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844054755",
            "telephone_number": "801-479-7850",
            "fax_number": "801-479-7825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5331 Adams Ave Pkwy Ste B",
            "address_purpose": "LOCATION",
            "city": "Ogden",
            "state": "UT",
            "postal_code": "844054755",
            "country_code": "US",
            "telephone_number": "801-479-7850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EYE DOCTOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-29",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "JEREMIAH",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "801-479-7850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Promontory Family Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Meaghen Evans
• Richard Patrick Evans Jr., CSW
• Steven Glenn Evans, ACMHC
• Ronda Annet Ewer, SSW
• Express Pox L.L.C.
• Eyemart Express LLC
• Sylvia R Eyre, LCSW
• F Craig Hazen Inc
• Leslie A. Fabian, PA
• Sarah D Facer

• Optometrist in Ogden, UT
• Providers in Ogden, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2020; 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.