Provider Demographics
NPI:1104798735
Name:CEDAR VALLEY EYECARE, LLC
Entity type:Organization
Organization Name:CEDAR VALLEY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-473-5127
Mailing Address - Street 1:4317 N PONY EXPRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-1230
Mailing Address - Country:US
Mailing Address - Phone:801-768-4100
Mailing Address - Fax:801-768-0600
Practice Address - Street 1:4317 N PONY EXPRESS PKWY
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-1230
Practice Address - Country:US
Practice Address - Phone:801-768-4100
Practice Address - Fax:801-768-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service