Individual
JASON TRENT PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4408 E PONY EXPRESS PKWY STE A, EAGLE MOUNTAIN, UT 84005-5564
(801) 789-3937
(801) 228-2420
Mailing address
7732 N RED OAK RD, EAGLE MOUNTAIN, UT 84005-4303
(801) 644-3046
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10382337-9934
UT
Other
Enumeration date
04/25/2016
Last updated
06/28/2021
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