Organization
AEG UTAH PROFESSIONAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA ALLISON (SR. DIRECTOR MANAGED VISION CARE)
(618) 604-5208
Entity
Organization
Contact information
Practice address
1300 N 200 E STE 104, LOGAN, UT 84341-2460
(435) 752-6453
Mailing address
111 E 4TH ST STE 440, ALTON, IL 62002-6206
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
07/11/2025
Last updated
07/11/2025
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