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General NPI Number Information
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NPI Number | 1477762805
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC PHYSICIANS LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 238 E STATE RD SUITE 4
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3620
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Country | US
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Telephone | 801-796-1054
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Fax | 801-796-1084
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Provider Business Mailing Address
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Address Line | 238 E STATE RD SUITE 4
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3620
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Country | US
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Telephone | 801-796-1054
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Fax | 801-796-1084
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Authorized Official
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Title or Position | MANAGER
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Name | KEVIN JAY FROMM
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Credential | O.D.
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Telephone | 801-796-1054
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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 | 375345-9934
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License Number State | UT
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