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General NPI Number Information
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NPI Number | 1396925269
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Entity Type | Organization
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Legal Business Name | BOUNTIFUL EYE CARE PC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 140 S MAIN ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6234
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Country | US
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Telephone | 801-295-2020
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Fax | 801-292-8761
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Provider Business Mailing Address
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Address Line | 140 S MAIN ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6234
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Country | US
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Telephone | 801-295-2020
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Fax | 801-292-8761
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MURRAY WILKES
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Credential | O.D.
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Telephone | 801-295-2020
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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 | 98-358145-9934
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License Number State | UT
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