Healthcare Provider Details

I. General information

NPI: 1073520680
Provider Name (Legal Business Name): DAVID BOYLE BURNETT O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 S 900 W
RIVERDALE UT
84405-3726
US

IV. Provider business mailing address

298 24TH ST STE 315
OGDEN UT
84401-1891
US

V. Phone/Fax

Practice location:
  • Phone: 801-627-9868
  • Fax: 801-627-9870
Mailing address:
  • Phone: 801-393-4413
  • Fax: 801-392-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56760929934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: