| NPI | 1669575833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY RAY SIVERTSON President 801-471-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 6246453-9934) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2020-08-22 |