Healthcare Provider Details

I. General information

NPI: 1629282439
Provider Name (Legal Business Name): OGDEN REFRACTIVE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 WASHINGTON BLVD STE. A
OGDEN UT
84403-1866
US

IV. Provider business mailing address

16305 SWINGLEY RIDGE RD STE. 300
CHESTERFIELD MO
63017-1777
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-0494
  • Fax:
Mailing address:
  • Phone: 636-534-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN L ANDREW
Title or Position: SECRETARY
Credential:
Phone: 636-534-2300