CENTRAL UTAH CLINIC, P.C. (NPI# 1265907620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265907620 |
| Entity Type | Organization |
| Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Practice Address |
5872 S 900 E Ste 100 Murray UT 84121-1677 |
| Mailing Address |
1055 N 500 W Attn: Credentialing Provo UT 84604-3305 |
| Practice Telephone | 8012610726 |
| Practice Fax Number | 8012622838 |
| Mailing Telephone | 8013548225 |
| Mailing Fax Number | 8014180941 |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2018-10-11 |
| Authorized Official Name | JED BRADLEY HARSTON (DIRECTOR OF MANAGED CARE) |
| Authorized Official Telephone | 8018125012 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRAL UTAH CLINIC, P.C. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| Optical Shop (Murray) | Other Name - Individual/Organization |
| Revere Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669930475 | Central Utah Clinic, P.C. | Clinic/Center | 330 Falcon Ridge Pkwy Ste 400a, Mesquite, NV 89027-8881 | 2019-03-11 |
| 1851631139 | Central Utah Clinic, P.C. | Internal Medicine | 2019 E Riverside Dr, Suite A200, St George, UT 84790-8134 | 2013-02-22 |
| 1508896838 | Central Utah Clinic, P.C. | Family Medicine | 97 S Professional Way, Suite 2, Payson, UT 84651-1614 | 2006-07-03 |
| 1316330749 | Central Utah Clinic, P.C. | Non-Pharmacy Dispensing Site | 1055 N 500 W Ste 202, Provo, UT 84604-3305 | 2015-03-10 |
| 1689003550 | Central Utah Clinic, P.C. | Clinic/Center | 555 W Sr 164, Salem, UT 84653 | 2013-11-01 |
| 1780017954 | Central Utah Clinic, P.C. | Orthopaedic Surgery | 700 W 800 N Ste 100, Orem, UT 84057-6302 | 2013-08-12 |
| 1760752943 | Central Utah Clinic, P.C. | Orthopaedic Surgery | 1490 E Foremaster Dr, Suite 150, St George, UT 84790-4488 | 2012-01-05 |
| 1841433927 | Central Utah Clinic, P.C. | Urology | 15 S 1000 E, Suite 225, Payson, UT 84651-5590 | 2009-04-20 |
| 1023251204 | Central Utah Clinic, P.C. | Clinic/Center | 3000 N Triumph Blvd Ste 100, Lehi, UT 84043-4999 | 2009-04-17 |
| 1437341427 | Central Utah Clinic, P.C. | Radiologic Technologist | 1055 N 500 W, Suite 102, Provo, UT 84604-3305 | 2007-08-14 |
| Street Address |
5872 S 900 E STE 100 |
| City | MURRAY |
| State | UT |
| Zip Code | 84121-1677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881980142 | David William Dodds | Ophthalmology | 5872 S 900 E Ste 100, Murray, UT 84121-1677 | 2011-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407483522 | Kaitlyn Horne | Behavior Technician | 6910 S. Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-26 |
| 1952936387 | Jared Wells | Behavior Technician | 6910 S Highland Drive, Cottonwood Heights, UT 84121 | 2020-03-05 |
| 1518591874 | Slc Plastic Surgery LLC | Plastic Surgery | 6686 Highland Drive, Cottonwood Heights, UT 84121 | 2020-02-26 |
| 1093273708 | Anna O'hearon | Counselor | New Roads Behavioral Health, 2450 Fort Union Blvd, Cottonwood Heights, UT 84121 | 2019-03-12 |
| 1053883181 | Charles Keller IIi | Pediatrics | 2198 S Yvonne Rd #344, Salt Lake City, UT 84121 | 2018-12-31 |
| 1669964516 | Marissa King | Specialist | 1141 E. 3900 S. Suite 150a, Salt Lake, UT 84121 | 2018-06-05 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1700315462 | Nelson & Tillmann Family Dentistry, PC | Dentist | 5872 S. 900 E. Ste 202, Salt Lake City, UT 84121 | 2017-06-07 |
| 1912430588 | Wasatch Midwifery and Wellness, LLC | Dietitian, Registered | 6440 S Wasatch Blvd, Ste 140, Holladay, UT 84121 | 2017-04-10 |
| 1407308331 | Tina Polgar | Registered Nurse | 6244 Highland Drive, Murray, UT 84121 | 2016-10-26 |
| Find all providers in zip 84121 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790225696 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 6117 S State St, Murray, UT 84107-7343 | 2017-02-27 |
| 1669562054 | Visionworks Inc | Eyewear Supplier (Equipment, not the service) | 148 E Winchester St, Area C D, Murray, UT 84107-7211 | 2006-10-13 |
| 1568561975 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 6191 S State St # 1200, Murray, UT 84107 | 2006-09-22 |
| 1326439530 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 5201 S Intermountain Dr, Murray, UT 84107-6024 | 2015-02-10 |
| 1215283247 | Optical Land,llc | Eyewear Supplier (Equipment, not the service) | 153 E 4370 S, Suite 7, Murray, UT 84107 | 2012-07-27 |
| 1144533506 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 6191 S State St, Murray, UT 84107-7258 | 2010-07-14 |
| 1720237951 | Clearview Optical Inc | Eyewear Supplier (Equipment, not the service) | 201 E 5900 S, Suite 101, Murray, UT 84107-5428 | 2008-09-11 |
| 1023175288 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 6191 S State St, Murray, UT 84107-7258 | 2007-01-03 |
| 1285797282 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 228 E 6400 S, Murray, UT 84107-7305 | 2006-12-19 |
| 1386750263 | Precision Eye Care Pllc | Eyewear Supplier (Equipment, not the service) | 6095 Fashion Blvd, Suite 110, Murray, UT 84107-7397 | 2006-08-22 |
| Find all providers in MURRAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.