MEDICARE: DANIEL STURGELL 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	12989955-9934	UT
2	152W00000X	Optometrist	OPT35874-TLG	CA

General Provider Information

NPI Number	:	1710609516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL STURGELL OD

Provider Business Mailing Address
First Line	:	3635 S BAYVIEW DR
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-3702
Country	:	US
Telephone Number	:	720-236-6726
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 W 2220 N
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-5744
Country	:	US
Telephone Number	:	801-779-0708
Fax Number	:

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

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	12/13/2024

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Directions to “ DANIEL STURGELL OD” Practice Location

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