| NPI | 1033301239 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | SHAUNE WALLACE President 435-674-3502 | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 6300367-9934) | 
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 6300367-9934) | 
| 152WP0200X Optometrist, Pediatrics (Licence: UT 6300367-9934) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 6300367-9934) | |
| Enumeration Date | 2007-08-13 | 
| Last Update Date | 2011-06-15 |