Healthcare Provider Details

I. General information

NPI: 1760956221
Provider Name (Legal Business Name): EYE PROS OF LAYTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1986 N HILL FIELD RD
LAYTON UT
84041-2109
US

IV. Provider business mailing address

3485 N COLE RD UNIT 45479
BOISE ID
83711-1095
US

V. Phone/Fax

Practice location:
  • Phone: 208-297-7019
  • Fax: 208-297-7518
Mailing address:
  • Phone: 208-297-7019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: LAVAR W KOFOED
Title or Position: OWNER
Credential: OD
Phone: 208-297-7019