| NPI | 1700322922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDON DEAN QUARNBERG Privacy Officer 801-316-5508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics |
| 152WV0400X Optometrist Vision Therapy | |
| 152WX0102X Optometrist Occupational Vision | |
| 156F00000X Technician/Technologist | |
| 156FC0800X Technician/Technologist Contact Lens | |
| 156FC0801X Technician/Technologist Contact Lens Fitter | |
| 156FX1800X Technician/Technologist Optician | |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2017-01-11 |