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General NPI Number Information
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NPI Number | 1659559979
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Entity Type | Organization
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Legal Business Name | KEITH W. LINFORD OD PC
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 4360 S WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84403
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Country | US
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Telephone | 801-390-5153
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Fax | 801-476-0067
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Provider Business Mailing Address
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Address Line | 4360 S WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84403
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Country | US
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Telephone | 801-390-5153
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Fax | 801-476-0067
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH W. LINFORD
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Credential | OD
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Telephone | 801-390-5153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1096749934
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License Number State | UT
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