Individual
GREG MICHAEL WENOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5735 HARRISON BLVD, OGDEN, UT 84403-4324
(801) 393-9440
Mailing address
1005 PINNOCCHIO DR, SALT LAKE CITY, UT 84116-2132
(801) 355-6613
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
277432-9934
UT
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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