Organization
PROVO VISION & EYE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BALTAZAR VEGA OD (OWNER/OPTOMETRIST)
(971) 217-9763
Entity
Organization
Contact information
Practice address
1313 S UNIVERSITY AVE, PROVO, UT 84601-5943
(971) 217-9763
Mailing address
323 W TWILIGHT CT, VINEYARD, UT 84059-5580
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
Other
Enumeration date
11/02/2019
Last updated
11/02/2019
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