Healthcare Provider Details

I. General information

NPI: 1770562985
Provider Name (Legal Business Name): DANE F DANSIE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 WASHINGTON BLVD
OGDEN UT
84403-1866
US

IV. Provider business mailing address

4360 WASHINGTON BLVD
OGDEN UT
84403-1866
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-0494
  • Fax:
Mailing address:
  • Phone: 801-476-0494
  • Fax: 801-476-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1118879934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: