Vineyard Eye Care LLC
Organization Active NPI Optometrist · Vineyard, UT
NPI 1760258552 · NPPES record last updated Mar 6, 2024
Key facts
- NPI
- 1760258552
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- VINEYARD EYE CARE LLC
- Practice address
- 691 E 400 N Ste 220
Vineyard, UT 84059-7510 - Phone
- (801) 717-5655
- NPI assigned
- Dec 1, 2023
- Organization subpart
- No
Authorized official
- Name
- Daxton Aaron Hawks, OD, MBA
- Title
- Optometrist
- Phone
- (801) 717-5655
Practitioners 1
-
Daxton Aaron Hawks, OD, MBA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240409003072 | UT | Part B Supplier - Clinic/Group Practice | 8628416724 |
Receives reassigned benefits from 1 practitioner Practice locations: Vineyard, UT |
National Provider Directory
Locations
691 E 400 N
Ste 220
Vineyard, UT 84059
Phone (801) 717-5655
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
691 E 400 N Ste 220
Vineyard, UT 84059-7510
Mailing address
691 E 400 N Ste 220
Vineyard, UT 84059-7510
Phone (801) 754-6955
Other providers in Vineyard, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2024. 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.