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General NPI Number Information
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NPI Number | 1679615660
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Entity Type | Organization
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Legal Business Name | JORDAN VISION CLINIC PC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 9237 REDWOOD RD BLDG 5A
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City | WEST JORDAN
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State | UT
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Zip | 84088-5812
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Country | US
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Telephone | 801-561-2020
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Fax | 801-255-3617
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Provider Business Mailing Address
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Address Line | 9237 REDWOOD RD BLDG 5A
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City | WEST JORDAN
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State | UT
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Zip | 84088-5812
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Country | US
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Telephone | 801-561-2020
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Fax | 801-255-3617
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROBERT H. MEEK
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Credential | O.D.
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Telephone | 801-561-2020
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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 | 1115039934
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License Number State | UT
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