| NPI | 1104123801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARROD DAVIES Optometrist 801-810-1060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 7383319-9934) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: UT 7383319-9934) |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 7383319-9934) | |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2020-06-02 |