Organization · Type 2 NPI

Central Utah Clinic, P.c.

Eyewear Supplier · Murray, UT

NPI number 1265907620 Active

Practice location

5872 S 900 E Ste 100
Murray, UT 84121-1677

Call (801) 261-0726 Map

Fax (801) 262-2838

Mailing address

1055 N 500 W, Attn: Credentialing
Provo, UT 84604-3305

Specialties and licenses

Taxonomy	Code	License
Eyewear Supplier Primary	332H00000X	None listed

Eyewear Supplier: An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

3 other providers at this address

Other eyewear supplier providers in Murray

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NPI record

NPI: 1265907620
Entity type: Organization (Type 2)
Issued: Oct 11, 2018
Last updated: Oct 11, 2018
Status: Active
Subpart: Yes of Central Utah Clinic, P.c.

Other names

Revere Health · doing business as
Optical Shop (murray) · other name

Authorized official

Jed Bradley Harston
Director of Managed Care
(801) 812-5012

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1265907620

Central Utah Clinic, P.c.'s National Provider Identifier is 1265907620, issued on Oct 11, 2018. The primary taxonomy on file is Eyewear Supplier (332H00000X), and the practice location is in Murray, UT. The record was last updated on Oct 11, 2018.