Provider Demographics
NPI:1235304064
Name:CLR VISION PC
Entity type:Organization
Organization Name:CLR VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIGTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-374-2227
Mailing Address - Street 1:1675 N 200 W #11A
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2570
Mailing Address - Country:US
Mailing Address - Phone:801-374-2227
Mailing Address - Fax:801-374-5197
Practice Address - Street 1:1675 N 200 W #11A
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2570
Practice Address - Country:US
Practice Address - Phone:801-374-2227
Practice Address - Fax:801-374-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5950660-9943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461538993001Medicaid
UT461538993001Medicaid