Healthcare Provider Details

I. General information

NPI: 1952664468
Provider Name (Legal Business Name): MASON ANTONE SCHMUTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 N STATE ST
PROVO UT
84604-1010
US

IV. Provider business mailing address

1735 N STATE ST
PROVO UT
84604-1010
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-1818
  • Fax: 801-374-0163
Mailing address:
  • Phone: 801-374-1818
  • Fax: 801-374-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number142145
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2252137
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number10343475-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: