Healthcare Provider Details

I. General information

NPI: 1942799234
Provider Name (Legal Business Name): JENNA O'BRIEN O.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 S WHITE SANDS DR
WASHINGTON UT
84780-8202
US

IV. Provider business mailing address

1038 S WHITE SANDS DR
WASHINGTON UT
84780-8202
US

V. Phone/Fax

Practice location:
  • Phone: 725-500-2493
  • Fax:
Mailing address:
  • Phone: 725-500-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNA O'BRIEN
Title or Position: OWNER
Credential: O.D.
Phone: 435-429-1686