Provider Demographics
NPI:1144484718
Name:SPECTRUM EYE CARE, LLC
Entity type:Organization
Organization Name:SPECTRUM EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORGILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-884-6562
Mailing Address - Street 1:225 E MAIN ST
Mailing Address - Street 2:STE E
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-9030
Mailing Address - Country:US
Mailing Address - Phone:435-884-6562
Mailing Address - Fax:
Practice Address - Street 1:225 E MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-9030
Practice Address - Country:US
Practice Address - Phone:435-884-6562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6630201-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty