Provider Demographics
NPI:1447378302
Name:CATARACT & LASIK CENTER OF UTAH PC
Entity type:Organization
Organization Name:CATARACT & LASIK CENTER OF UTAH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGEON DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-224-6767
Mailing Address - Street 1:175 N 400 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-1909
Mailing Address - Country:US
Mailing Address - Phone:801-224-6767
Mailing Address - Fax:801-221-1052
Practice Address - Street 1:175 N 400 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:801-224-6767
Practice Address - Fax:801-221-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2619191205152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164613790OtherFACILITY NPI
UT1447378302OtherGROUP NPI
UT1619075678OtherNPI
UT1447378302OtherGROUP NPI
UT1619075678OtherNPI
UT000055412Medicare PIN