Individual
DR. LANNY F DUCLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
88 E 700 N, STE A, TOOELE, UT 84074-1817
(435) 882-6452
(435) 882-3170
Mailing address
88 E 700 N, STE A, TOOELE, UT 84074-1817
(435) 882-6452
(435) 882-3170
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1138799934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10898
—
UT
01
—
1804229
WORKERS COMPENSATION
UT
01
—
39123
PEHP
UT
05
—
D1110
—
UT
05
—
PR07206
—
UT
01
—
QM0000016583
ALTIUS
UT
05
—
TPRA06734
—
UT
Enumeration date
03/31/2006
Last updated
11/01/2007
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