Healthcare Provider Details

I. General information

NPI: 1568690568
Provider Name (Legal Business Name): PAUL HULET O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5528 W 13400 S
HERRIMAN UT
84096-6919
US

IV. Provider business mailing address

5528 W 13400 S
HERRIMAN UT
84096-6919
US

V. Phone/Fax

Practice location:
  • Phone: 801-302-3080
  • Fax: 801-302-8008
Mailing address:
  • Phone: 801-302-3080
  • Fax: 801-302-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7386687-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: