Healthcare Provider Details

I. General information

NPI: 1073594818
Provider Name (Legal Business Name): CONLEY BEN CALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 E 900 N
SPANISH FORK UT
84660-1232
US

IV. Provider business mailing address

PO BOX 1655
SPANISH FORK UT
84660-7655
US

V. Phone/Fax

Practice location:
  • Phone: 801-794-4964
  • Fax: 801-798-8298
Mailing address:
  • Phone: 801-794-4964
  • Fax: 801-798-8298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00043676
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number38787
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number8062924-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number45603
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: