Healthcare Provider Details

I. General information

NPI: 1043465032
Provider Name (Legal Business Name): DARCY H. WOLSEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E 3300 S #B
SLC UT
84106-2849
US

IV. Provider business mailing address

409 3RD AVE
SALT LAKE CITY UT
84103-2648
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-2020
  • Fax: 801-487-3687
Mailing address:
  • Phone: 801-750-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number2921121205
License Number StateUT

VIII. Authorized Official

Name: DARCY HUNT WOLSEY
Title or Position: OWNER
Credential: MD
Phone: 801-750-1967