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NPI Code Detail

MEDICARE: JEFFERY J THATCHER OD

MEDICARE: JEFFERY J THATCHER 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
1152W00000XOptometrist4132139934UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101697OTHERUTIHC

General Provider Information

NPI Number : 1750351979
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY J THATCHER OD
Provider Business Mailing Address
First Line : 625 W TELEGRAPH ST
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-1541
Country : US
Telephone Number : 435-986-3770
Fax Number : 435-986-3772
Provider Business Practice Location Address
First Line : 625 W TELEGRAPH ST
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-1541
Country : US
Telephone Number : 435-986-3770
Fax Number : 435-986-3772
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 09/13/2010

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