Healthcare Provider Details

I. General information

NPI: 1740255058
Provider Name (Legal Business Name): DAVID J ESPLIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 S 400 W
SPANISH FORK UT
84660-2053
US

IV. Provider business mailing address

PO BOX 267
SPANISH FORK UT
84660-0267
US

V. Phone/Fax

Practice location:
  • Phone: 801-794-3937
  • Fax: 801-794-9880
Mailing address:
  • Phone: 801-794-3937
  • Fax: 801-794-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56790148908
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: