Organization
ROOSEVELT VISION CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT H KOWALLIS O.D. (OWNER/DOCTOR)
(435) 722-2981
Entity
Organization
Contact information
Practice address
165 W 200 N, 71-7, ROOSEVELT, UT 84066-2834
(435) 722-2981
(435) 722-3732
Mailing address
165 W 200 N, 71-7, ROOSEVELT, UT 84066-2834
(435) 722-2981
(435) 722-3732
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
111999-9934
UT
Other
Enumeration date
09/22/2005
Last updated
08/27/2008
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