Kevin Mark Ellsworth in Logan - Optometrist
Kevin Mark Ellsworth - NPI 1669457024
Kevin Mark Ellsworth is a Optometrist in Logan, Utah. Kevin Mark Ellsworth practices all healthcare services and medical treatments related to Optometrist. The NPI Number for Kevin Mark Ellsworth is 1669457024. The last update date is 2008-08-20.
Kevin Mark Ellsworth's current location address is 395 E 1400 N, Logan, Utah. You can contact this provider via phone number 4357525585 and fax number 4357872871. The mailing address for Kevin Mark Ellsworth is 395 E 1400 N, Logan, Utah. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kevin Mark Ellsworth |
|---|---|
| Address | 395 E 1400 N, Logan, Utah |
| Phone Number | 4357525585 |
| Fax Number | 4357872871 |
| Sole Proprietor | Y |
| Credentials | O.D. |
NPI Number Detail
| NPI Number | 1669457024 |
|---|---|
| Provider Enumeration Date | 2005-12-08 |
| Last Updated Date | 2008-08-20 |
Provider Mailing Address Detail
| Address | 395 E 1400 N |
|---|---|
| City | Logan |
| State | Utah (UT) |
| Post Code | 843417573 |
| Phone Number | 4357525585 |
| Fax Number | 4357872871 |
Provider's Primary Taxonomy Detail
| Speciality | Optometrist |
|---|---|
| Taxonomy | 152W00000X |
| Licence No | 112376-9934 |
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Definition: Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related |
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What is the Kevin Mark Ellsworth's unique identification number?
The Kevin Mark Ellsworth has been assigned the NPI (National Provider Identifier) Number 1669457024 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you please provide the complete street address where Kevin Mark Ellsworth is physically located?
The Kevin Mark Ellsworth is physically situated at the following address: 395 E 1400 N, Logan, UT, 843417573.
What is the Kevin Mark Ellsworth's area of specialization and corresponding taxonomy classification?
The Kevin Mark Ellsworth's specialty field is Optometrist, and it falls under the taxonomy code 152W00000X, which categorizes healthcare providers based on their specialties.
On what date did the Kevin Mark Ellsworth receive its 1669457024 assignment from the Centers for Medicare & Medicaid Services?
The Kevin Mark Ellsworth was assigned its 1669457024 by the Centers for Medicare & Medicaid Services on 2005-12-08.
As of what date were the details related to Kevin Mark Ellsworth most recently updated or revised?
The information pertaining to Kevin Mark Ellsworth, including its address, specialty, and other relevant details, was last updated or revised on 2008-08-20.
NPI Number: 1376546309
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