MEDICARE: DR. KEVIN JAY FROMM O.D.

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	375345-9934	UT

General Provider Information

NPI Number	:	1659347144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JAY FROMM O.D.

Provider Business Mailing Address
First Line	:	5455 W 11000 N
Second Line	:	SUITE 101
City	:	HIGHLAND
State	:	UT
Zip	:	84003-8800
Country	:	US
Telephone Number	:	801-756-9357
Fax Number	:	801-756-9358

Provider Business Practice Location Address
First Line	:	5455 W 11000 N
Second Line	:	SUITE 101
City	:	HIGHLAND
State	:	UT
Zip	:	84003-8800
Country	:	US
Telephone Number	:	801-756-9357
Fax Number	:	801-756-9358

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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