MEDICARE: TAYLOR WENDELL HUNSAKER 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	12868110-9934	UT

General Provider Information

NPI Number	:	1629716170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR WENDELL HUNSAKER OD

Provider Business Mailing Address
First Line	:	3300 MAIN ST UNIT 3
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-3231
Country	:	US
Telephone Number	:	801-628-1455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 N 1400 W STE 24
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5237
Country	:	US
Telephone Number	:	435-656-2003
Fax Number	:

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

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	05/24/2022

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