Individual
TYLER WAYNE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
500 FOOTHILL DR, OPTOMETRY DEPARTMENT (112), SALT LAKE CITY, UT 84148-0001
(801) 582-1565
Mailing address
127 W 3100 S, BOUNTIFUL, UT 84010-6521
(702) 513-8201
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9050293-9934
UT
152WC0802X
Corneal and Contact Management Optometrist
9050293-9934
UT
Other
Enumeration date
06/11/2014
Last updated
06/11/2014
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