Healthcare Provider Details

I. General information

NPI: 1538807573
Provider Name (Legal Business Name): VISION SOURCE OF SOUTH OGDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 ADAMS AVE PKWY STE B
OGDEN UT
84405-4755
US

IV. Provider business mailing address

1741 N 2000 W STE 7
FARR WEST UT
84404-9811
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-7850
  • Fax:
Mailing address:
  • Phone: 801-643-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. IAN WHIPPLE
Title or Position: PRESIDENT
Credential: OD
Phone: 801-731-5558