Individual
DR. KEVIN MARK ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
395 E 1400 N, SUITE B, LOGAN, UT 84341-7573
(435) 752-5585
(435) 787-2871
Mailing address
395 E 1400 N, SUITE B, LOGAN, UT 84341-7573
(435) 752-5585
(435) 787-2871
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
112376-9934
UT
Other
Enumeration date
12/08/2005
Last updated
08/20/2008
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