Healthcare Provider Details

I. General information

NPI: 1366443079
Provider Name (Legal Business Name): JEFFREY PAUL TIPTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W HILLFIELD RD
LAYTON UT
84041-4614
US

IV. Provider business mailing address

3162 W 1100 N
WEST POINT UT
84015-7571
US

V. Phone/Fax

Practice location:
  • Phone: 801-444-7160
  • Fax:
Mailing address:
  • Phone: 801-444-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number348415-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: