Organization
MOBILE EYECARE OF UTAH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAUN DEAN LARSEN O.D. (OWNER)
(801) 250-5745
Entity
Organization
Contact information
Practice address
3665 S 8400 W, SUITE 100, MAGNA, UT 84044-2214
(801) 250-5745
(801) 250-5981
Mailing address
3665 S 8400 W, SUITE 100, MAGNA, UT 84044-2214
(801) 250-5745
(801) 250-5981
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3758049934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528455690016
—
UT
Enumeration date
06/16/2006
Last updated
08/26/2010
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