Basic Information
| Provider Information | |||||||||
| NPI: | 1851478606 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVEC EYE CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95970 | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840950970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 8789 S HIGHLAND DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840931602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019434999 | ||||||||
| FaxNumber: | 8019433876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHOU | ||||||||
| AuthorizedOfficialFirstName: | STELLA | ||||||||
| AuthorizedOfficialMiddleName: | YI | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8015010035 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 325931-1205 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | D2940 | 01 | UT | MEDICAID LICENSE NUMBER | OTHER | 1851478606 | 05 | UT | MEDICAID |