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General NPI Number Information
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NPI Number | 1396669438
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Entity Type | Individual
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Provider Name | KYLAN TREVOR HEATON OD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 910 S 300 W
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City | BLANDING
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State | UT
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Zip | 84511-3921
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Country | US
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Telephone | 435-678-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 910 S 300 W
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City | BLANDING
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State | UT
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Zip | 84511-3921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14299610
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License Number State | UT
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