Provider Demographics
NPI:1366883936
Name:SOUTHWEST VISION, LLC
Entity type:Organization
Organization Name:SOUTHWEST VISION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RABISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-676-8646
Mailing Address - Street 1:965 E 700 S
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4082
Mailing Address - Country:US
Mailing Address - Phone:435-673-5577
Mailing Address - Fax:435-688-0381
Practice Address - Street 1:415 E CENTER ST
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759-0976
Practice Address - Country:US
Practice Address - Phone:435-676-8646
Practice Address - Fax:435-676-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5679342-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528352394017Medicaid
UTU69391Medicare UPIN
V02979Medicare UPIN