Individual
MICHAEL GREEN THAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6895 SO STATE, SALT LAKE CITY, UT 84047
(801) 255-8525
Mailing address
12964 HUNTER HOLLOW WAY, DRAPER, UT 84020
(801) 572-0594
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1089949934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S29660765001
—
UT
Enumeration date
11/20/2006
Last updated
07/08/2007
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