Individual
BENJAMIN T DASTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1483 E RIDGELINE DR STE 100, SOUTH OGDEN, UT 84405-4977
(801) 399-1149
(801) 399-0248
Mailing address
875 COUNTRY HILLS DR, OGDEN, UT 84403-2200
(801) 399-1149
(801) 394-4481
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01062307
IN
207W00000X
Ophthalmology Physician
Primary
5484681
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000069325
PTAN (SELF)
UT
05
—
1073797809
—
UT
Enumeration date
12/28/2007
Last updated
10/09/2025
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