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Individual

JACOB HANSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
1295 N CANYON CREEK PKWY, SPANISH FORK, UT 84660-1319
(801) 504-9645
Mailing address
1295 N CANYON CREEK PKWY, SPANISH FORK, UT 84660-1319
(801) 504-9645

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9432999-9934
UT
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/10/2019
Last updated
10/23/2024
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