Individual
DR. DAVID D MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2028 W 2220 N, CLINTON, UT 84015-5744
(801) 779-0708
(385) 393-7875
Mailing address
2028 W 2220 N, CLINTON, UT 84015-5744
(801) 779-0708
(385) 393-7875
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0601800582
VA
152W00000X
Optometrist
18003429 A & B
IN
152W00000X
Optometrist
Primary
361378-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010118166
—
VA
01
—
162686
ANTHEM BLUE CROSS
VA
01
—
P00190241
PALMETTO RAILROAD MEDICAR
VA
Enumeration date
06/28/2005
Last updated
10/24/2024
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