Organization
LANNY F DUCLOS OD PC
Active
Other names
Eye Health Professionals
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANNY F DUCLOS OD (CEO)
14358826452
Entity
Organization
Contact information
Practice address
88 E 700 N, SUITE A, TOOELE, UT 84074-1818
(435) 882-6452
(435) 882-3170
Mailing address
88 E 700 N, SUITE A, TOOELE, UT 84074-1818
(435) 882-6452
(435) 882-3170
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
113879-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005327246
AETNA
UT
05
—
100510174
—
NV
01
—
101001656101
SELECT HEALTH
UT
05
—
10898
—
UT
01
—
17036
HOMETOWN HEALTH
UT
01
—
258200
DMBA
UT
05
—
528118588003
—
UT
05
—
80314
—
UT
05
—
TPRA06734
—
UT
05
—
W0620
—
UT
Enumeration date
10/20/2006
Last updated
04/30/2008
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