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General NPI Number Information
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NPI Number | 1316740889
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Entity Type | Organization
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Legal Business Name | MAIN STREET PROS LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 24 W MAIN ST
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2318
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Country | US
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Telephone | 801-756-7996
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Fax |
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Provider Business Mailing Address
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Address Line | 25 W TELEGRAPH ST UNIT 906
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City | WASHINGTON
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State | UT
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Zip | 84780-6036
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Country | US
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Telephone | 435-650-1145
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH AARON SMITH
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Credential | OD
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Telephone | 435-650-1145
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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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