Healthcare Provider Details

I. General information

NPI: 1992005938
Provider Name (Legal Business Name): DR. JEFFREY TIPTON OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W HILL FIELD 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: 801-510-1541
  • Fax:
Mailing address:
  • Phone: 801-728-4569
  • 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: JEFFREY TIPTON
Title or Position: PRESIDENT
Credential:
Phone: 801-728-4569