MEDICARE: TED HEMSLEY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	108920-9934	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619058401	OTHER	UT	B;UE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619058401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED HEMSLEY OD

Provider Business Mailing Address
First Line	:	1901 PARKWAY BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84119-2001
Country	:	US
Telephone Number	:	801-886-2020
Fax Number	:	801-954-0054

Provider Business Practice Location Address
First Line	:	1076 LAYTON HILLS MALL
Second Line	:	#2090
City	:	LAYTON
State	:	UT
Zip	:	84041-2104
Country	:	US
Telephone Number	:	801-546-0255
Fax Number	:	801-546-0260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	09/03/2009

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