Healthcare Provider Details

I. General information

NPI: 1578031597
Provider Name (Legal Business Name): HIGHLAND OPTOMETRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7291 BOULDER AVENUE SUITE #2D
HIGHLAND CA
92346
US

IV. Provider business mailing address

749 S RIVER RD
SAINT GEORGE UT
84790-5509
US

V. Phone/Fax

Practice location:
  • Phone: 909-425-1212
  • Fax: 909-425-2485
Mailing address:
  • Phone: 435-628-4464
  • Fax: 435-628-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM J LOFGRAN
Title or Position: OWNER
Credential: O.D.
Phone: 435-680-0055