Provider Demographics
NPI:1184126963
Name:HIDDEN VALLEY EYECARE AND FRAMED OPTICAL, PLLC
Entity type:Organization
Organization Name:HIDDEN VALLEY EYECARE AND FRAMED OPTICAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-334-1664
Mailing Address - Street 1:1147 E DRAPER PKWY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9096
Mailing Address - Country:US
Mailing Address - Phone:801-916-9555
Mailing Address - Fax:
Practice Address - Street 1:1147 E DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9096
Practice Address - Country:US
Practice Address - Phone:801-916-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10650496-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty