Healthcare Provider Details

I. General information

NPI: 1730350505
Provider Name (Legal Business Name): RICH H. HUMPHERYS, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N WASHINGTON BLVD
OGDEN UT
84404-3605
US

IV. Provider business mailing address

1055 N WASHINGTON BLVD
OGDEN UT
84404-3605
US

V. Phone/Fax

Practice location:
  • Phone: 801-394-5709
  • Fax: 801-394-5710
Mailing address:
  • Phone: 801-394-5709
  • Fax: 801-394-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICH HANSEN HUMPHERYS
Title or Position: OWNER
Credential: O.D.
Phone: 801-394-5709