Healthcare Provider Details

I. General information

NPI: 1568955623
Provider Name (Legal Business Name): TAYLOR WOODWARD LINTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 3600
OGDEN UT
84403-3285
US

IV. Provider business mailing address

4403 HARRISON BLVD STE 3600
OGDEN UT
84403-3285
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-3550
  • Fax: 801-387-3559
Mailing address:
  • Phone: 801-387-3550
  • Fax: 801-387-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10860117-9934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: