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General NPI Number Information
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NPI Number | 1265220065
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Entity Type | Organization
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Legal Business Name | EYEMAZING
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 335 N 300 W STE 101
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City | KAYSVILLE
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State | UT
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Zip | 84037-1815
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Country | US
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Telephone | 801-643-4277
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Fax |
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Provider Business Mailing Address
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Address Line | 3824 THURSTON DR
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City | MORGAN
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State | UT
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Zip | 84050-9906
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Country | US
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Telephone | 304-992-4511
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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 | KYLE FUSSELMAN
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Credential | DO
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Telephone | 304-992-4511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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