Individual
MICHAEL LONNIE BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4360 WASHINGTON BLVD, OGDEN, UT 84403-1866
(801) 476-0494
(801) 476-0067
Mailing address
4360 WASHINGTON BLVD, OGDEN, UT 84403-1866
(801) 476-0494
(801) 476-0067
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
9073398-1205
UT
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
9073398-1205
UT
Other
Enumeration date
07/14/2010
Last updated
04/20/2020
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