Healthcare Provider Details

I. General information

NPI: 1770909632
Provider Name (Legal Business Name): HARLIN EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 S QUARRY BEND DR
SANDY UT
84094-7701
US

IV. Provider business mailing address

PO BOX 886
SANDY UT
84091-0886
US

V. Phone/Fax

Practice location:
  • Phone: 801-352-4207
  • Fax: 801-352-4220
Mailing address:
  • Phone: 801-352-4207
  • Fax: 801-352-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5948040-9934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number5948040-9934
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number5948040-9934
License Number StateUT

VIII. Authorized Official

Name: DR. DUSTIN DERIC HARLIN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 801-352-4207