MEDICARE: DR. BLAINE F BIRD 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	152WC0802X	Corneal and Contact Management Optometrist	114554-8908	UT
2	152WP0200X	Pediatric Optometrist	114554-9934	UT
3	152WS0006X	Sports Vision Optometrist	114554-9934	UT
4	152W00000X	Optometrist	114554-9934	UT

General Provider Information

NPI Number	:	1871581652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAINE F BIRD O.D.

Provider Business Mailing Address
First Line	:	1055 N 300 W
Second Line	:	SUITE 204
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-357-7373
Fax Number	:	801-357-7217

Provider Business Practice Location Address
First Line	:	1055 N 300 W
Second Line	:	SUITE 204
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-357-7373
Fax Number	:	801-357-7217

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	06/10/2020

Similar Medicare Providers

1811995004 — DR. DOUGLAS SCHOW JR. M.D.
Practice Location Address:

1055 N 300 W , STE 203
PROVO, UT
84604-3344

Practice Phone: 801-374-9053
Practice Fax: 801-357-7869

1871580829 — JOHN ZACHARY PA
Practice Location Address:

1055 N 300 W , STE. 500
PROVO, UT
84604-3344

Practice Phone: 801-357-7291
Practice Fax: 801-357-7919

1962476002 — DR. RICHARD WESLEY LATER M.D.
Practice Location Address:

1055 N 300 W , #311
PROVO, UT
84604-3344

Practice Phone: 801-357-7883
Practice Fax: 801-357-7975

1356319842 — SANDRA V ARCHER MD
Practice Location Address:

1055 N 300 W , SUITE 110
PROVO, UT
84604-3344

Practice Phone: 801-357-7377
Practice Fax: 801-357-7377

1326096728 — INTERMOUNTAIN HEALTHCARE
Practice Location Address:

1055 N 300 W , 500
PROVO, UT
84604-3344

Practice Phone: 801-357-7291
Practice Fax:

1396794277 — INTERMOUNTAIN HEATHCARE
Practice Location Address:

1055 N 300 W , 500
PROVO, UT
84604-3344

Practice Phone: 801-357-7291
Practice Fax:

Directions to “ DR. BLAINE F BIRD O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.