| NPI | 1053547141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDAL NYLAN ELLSWORTH Owner 435-656-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: UT 274205-1205) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |