Organization
MODERN VISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY L NIELSEN OD (MANAGER, OWNER, OPTOMETRIST)
(801) 919-5154
Entity
Organization
Contact information
Practice address
3571 W SOUTH JORDAN PKWY, SOUTH JORDAN, UT 84095-7173
(801) 523-5303
(801) 523-5301
Mailing address
1043 N 1000 W, AMERICAN FORK, UT 84003-3897
(801) 919-5154
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
UT
Other
Enumeration date
06/01/2017
Last updated
06/01/2017
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