Healthcare Provider Details

I. General information

NPI: 1760744494
Provider Name (Legal Business Name): JOSEPH AARON SMITH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 W TELEGRAPH ST 3
WASHINGTON UT
84780-1671
US

IV. Provider business mailing address

PO BOX 273
SANDY UT
84091-0273
US

V. Phone/Fax

Practice location:
  • Phone: 435-634-6737
  • Fax:
Mailing address:
  • Phone: 435-650-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number82567548908
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: