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General NPI Number Information
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NPI Number | 1235395377
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF UTAH HOSPITALS AND CLINICS
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1492 W ANTELOPE DR STE. 150
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City | LAYTON
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State | UT
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Zip | 84041-1139
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Country | US
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Telephone | 801-776-7804
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 510708
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City | SALT LAKE CITY
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State | UT
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Zip | 84151-0708
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Country | US
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Telephone | 801-587-6303
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUSAN A TERRY
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Credential | MD
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Telephone | 801-587-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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