MEDICARE: DR. DAVID R MASIHDAS O D P C

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	152WC0802X	Corneal and Contact Management Optometrist	1107939934	UT

General Provider Information

NPI Number	:	1821079989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R MASIHDAS O D P C

Provider Business Mailing Address
First Line	:	150 S 1000 E STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1496
Country	:	US
Telephone Number	:	801-363-2851
Fax Number	:	801-363-7186

Provider Business Practice Location Address
First Line	:	150 S 1000 E STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1496
Country	:	US
Telephone Number	:	801-363-2851
Fax Number	:	801-363-7186

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/18/2020

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