Healthcare Provider Details

I. General information

NPI: 1619653789
Provider Name (Legal Business Name): KOW HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E 6400 S
MURRAY UT
84107-7305
US

IV. Provider business mailing address

345 W 600 S STE 118
HEBER CITY UT
84032-2283
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-9125
  • Fax:
Mailing address:
  • Phone: 435-305-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RILEY RISTO
Title or Position: MANAGING MEMBER
Credential:
Phone: 435-305-9014