Healthcare Provider Details

I. General information

NPI: 1497937981
Provider Name (Legal Business Name): PAUL E REED OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N 2000 W
FARR WEST UT
84404-9541
US

IV. Provider business mailing address

1761 N 2000 W
FARR WEST UT
84404-9541
US

V. Phone/Fax

Practice location:
  • Phone: 801-731-5558
  • Fax: 801-731-3143
Mailing address:
  • Phone: 801-731-5558
  • Fax: 801-731-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3694249934
License Number StateUT

VIII. Authorized Official

Name: DR. PAUL EDWARD REED
Title or Position: PRESIDENT
Credential: O.D.
Phone: 801-731-5558