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General NPI Number Information
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NPI Number | 1558434613
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Entity Type | Organization
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Legal Business Name | BOUNTIFUL VISION PLAZA PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 311 E 500 S
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4924
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Country | US
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Telephone | 801-295-4441
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Fax | 801-294-5416
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Provider Business Mailing Address
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Address Line | 311 E 500 S
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4924
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Country | US
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Telephone | 801-295-4441
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Fax | 801-294-5416
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. DOUGLAS R SMITH
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Credential | OD
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Telephone | 801-295-4441
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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 | 1128829934
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License Number State | UT
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