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NPI Code Detail

MEDICARE: DR. DANE F DANSIE O.D.

MEDICARE: DR. DANE F DANSIE 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
1152W00000XOptometrist1118879934UT

General Provider Information

NPI Number : 1770562985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANE F DANSIE O.D.
Provider Business Mailing Address
First Line : 4360 WASHINGTON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-1866
Country : US
Telephone Number : 801-476-0494
Fax Number : 801-476-0067
Provider Business Practice Location Address
First Line : 4360 WASHINGTON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-1866
Country : US
Telephone Number : 801-476-0494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2006
Last Update Date : 05/01/2012

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