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Organization
SALT LAKE RETINA, LLC
Active
Organization
SALT LAKE RETINA, LLC
Active
Other names
Salt Lake Retina
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS S MEHR MD (PRESIDENT)
(801) 260-0034
Entity
Organization
Contact information
Practice address
3855 W 7800 S, SUITE 100, WEST JORDAN, UT 84088-5560
(801) 260-0034
(801) 260-0035
Mailing address
3855 W 7800 S, SUITE 100, WEST JORDAN, UT 84088-5560
(801) 260-0034
(801) 260-0035
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
5934492-1205
UT
207W00000X
Ophthalmology Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508052234
—
UT
Enumeration date
09/19/2014
Last updated
04/10/2023
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