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General NPI Number Information
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NPI Number | 1619606340
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Entity Type | Individual
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Provider Name | JEFFREY WESTERN OD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 13454 S MONARCH MEADOWS PKWY
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City | RIVERTON
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State | UT
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Zip | 84096-2562
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Country | US
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Telephone | 801-254-7575
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Fax |
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Provider Business Mailing Address
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Address Line | 9387 S KOCH DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-4688
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Country | US
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Telephone | 801-358-0949
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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 | 12888596-9934
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License Number State | UT
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