| NPI | 1538399761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN JOHNSEN Owner 801-699-5945 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207WX0200X Ophthalmology Ophthalmic Plastic and Reconstructive Surgery |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2019-01-17 |