Organization
CENTRAL UTAH CLINIC, P.C.
Active
Parent organization
CENTRAL UTAH CLINIC, P.C.
Other names
Optical Shop (Murray), Revere Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRAL UTAH CLINIC, P.C.
Authorized official
JED BRADLEY HARSTON (DIRECTOR OF MANAGED CARE)
(801) 812-5012
Entity
Organization
Contact information
Practice address
5872 S 900 E STE 100, MURRAY, UT 84121-1677
(801) 261-0726
(801) 262-2838
Mailing address
1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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