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General NPI Number Information
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NPI Number | 1518975226
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Entity Type | Individual
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Provider Name | JEFFERY LOVELL MELLOR O.D., M.ED.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 10412 S 2200 W
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8333
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Country | US
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Telephone | 801-858-2020
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Fax | 801-610-2138
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Provider Business Mailing Address
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Address Line | 15037 WINGED BLUFF LN
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City | DRAPER
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State | UT
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Zip | 84020-5719
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Country | US
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Telephone | 801-649-3692
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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 | 328094-9934
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License Number State | UT
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