| NPI | 1902975121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY V FELLOWS Owner President 801-566-4119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 1135088908) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2020-08-22 |