Healthcare Provider Details

I. General information

NPI: 1619058401
Provider Name (Legal Business Name): TED HEMSLEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 LAYTON HILLS MALL #2090
LAYTON UT
84041-2104
US

IV. Provider business mailing address

1901 PARKWAY BLVD
SALT LAKE CITY UT
84119-2001
US

V. Phone/Fax

Practice location:
  • Phone: 801-546-0255
  • Fax: 801-546-0260
Mailing address:
  • Phone: 801-886-2020
  • Fax: 801-954-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number108920-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: