Healthcare Provider Details

I. General information

NPI: 1295724151
Provider Name (Legal Business Name): JOSEPH PATRICK MCFADDEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 11TH ST 75 MDG/SGPFE
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

1928 E SUNSET DR
LAYTON UT
84040-5708
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-4832
  • Fax: 801-586-9567
Mailing address:
  • Phone: 801-544-9381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: