Healthcare Provider Details

I. General information

NPI: 1851736359
Provider Name (Legal Business Name): WARD EYE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 E 3900 S STE 104
SALT LAKE CITY UT
84124-1464
US

IV. Provider business mailing address

3879 E RUTH DR
SALT LAKE CITY UT
84124-2326
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-5310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number8526932-1205
License Number StateUT

VIII. Authorized Official

Name: DR. MATTHEW WARD
Title or Position: OWNER
Credential: M.D.
Phone: 801-810-5310