Individual
DR. JESS ERIC MENDENHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
482 S MAIN ST, SPANISH FORK, UT 84660-2410
(801) 504-6448
(801) 504-6239
Mailing address
203 E 1600 S, MAPLETON, UT 84664-5204
(520) 678-6567
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
7070612-8908
UT
152W00000X
Optometrist
Primary
7070612-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225280423
—
UT
01
—
12457053
CAQH
—
Enumeration date
10/21/2008
Last updated
12/08/2014
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