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Organization
BLAINE F. BIRD, O.D., P.C.
Active
Organization
BLAINE F. BIRD, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE F BIRD O.D. (PRESIDENT)
(801) 374-2220
Entity
Organization
Contact information
Practice address
2255 N UNIVERSITY PKWY, SUITE #1, PROVO, UT 84604-1588
(801) 374-2220
(801) 373-5439
Mailing address
2255 N UNIVERSITY PKWY STE 1, PROVO, UT 84604-7505
(801) 374-2220
(801) 373-5439
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1145549934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871581652
BLUE CROSS BLUE SHIELD
UT
05
—
529961264004
—
UT
Enumeration date
06/07/2007
Last updated
12/29/2008
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