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General NPI Number Information
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NPI Number | 1801127634
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Entity Type | Organization
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Legal Business Name | WASATCH VIEW EYE AND LASER CLINIC LLC
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 922 BAXTER DR 110
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8613
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Country | US
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Telephone | 801-542-7024
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Fax |
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Provider Business Mailing Address
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Address Line | 922 BAXTER DR 110
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8613
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Country | US
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Telephone | 801-542-7024
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Fax |
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Authorized Official
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Title or Position | MEMBER/DOCTOR
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Name | DR. JEFFERY L MELLOR
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Credential | OD
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Telephone | 801-867-9382
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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 | 328094-9934
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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