Provider Demographics
NPI:1447340799
Name:WENDOVER EYE CARE, INC
Entity type:Organization
Organization Name:WENDOVER EYE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-665-7923
Mailing Address - Street 1:307 N 300 W
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1852
Mailing Address - Country:US
Mailing Address - Phone:435-665-7923
Mailing Address - Fax:435-665-7923
Practice Address - Street 1:479 E WENDOVER BLVD
Practice Address - Street 2:
Practice Address - City:WENDOVER
Practice Address - State:UT
Practice Address - Zip Code:84083
Practice Address - Country:US
Practice Address - Phone:435-665-7923
Practice Address - Fax:435-665-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT62579469934152W00000X
UT1138799934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
62579469902001OtherBLUE CROSS BLUE SHIELD
UT=========OtherEVEREST
UT=========001Medicaid
UT=========OtherPEPPERMILL HOMETOWN H
NV=========OtherABD (ELKO COUNTY)
UT6050080001Medicare NSC