Provider Demographics
NPI:1447397658
Name:APPLE CONTACT LENS CENTER INC.
Entity type:Organization
Organization Name:APPLE CONTACT LENS CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-963-2773
Mailing Address - Street 1:2282 W 5400 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1744
Mailing Address - Country:US
Mailing Address - Phone:801-963-2773
Mailing Address - Fax:801-963-2692
Practice Address - Street 1:2282 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1744
Practice Address - Country:US
Practice Address - Phone:801-963-2773
Practice Address - Fax:801-963-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT921111919934305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1144395203OtherDOCTOR'S NPI
UT381487205037Medicaid
UT1144395203OtherDOCTOR'S NPI
UTU65943Medicare UPIN