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General NPI Number Information
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NPI Number | 1538807573
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Entity Type | Organization
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Legal Business Name | VISION SOURCE OF SOUTH OGDEN
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Dates
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Enumeration Date | 05/20/2022
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Last Update Date | 07/12/2022
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Provider Practice Location Address
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Address Line | 5331 ADAMS AVE PKWY STE B
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City | OGDEN
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State | UT
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Zip | 84405-4755
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Country | US
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Telephone | 801-479-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 1741 N 2000 W STE 7
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City | FARR WEST
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State | UT
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Zip | 84404-9811
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Country | US
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Telephone | 801-643-1001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IAN WHIPPLE
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Credential | OD
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Telephone | 801-731-5558
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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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