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Individual

DR. JERRY DALE CARLSON

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
955 N MAIN ST, SPANISH FORK, UT 84660-1150
(801) 798-3557
Mailing address
955 N MAIN ST, SPANISH FORK, UT 84660-1150
(801) 798-3557

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5154950-9934
UT

Other

Enumeration date
05/30/2006
Last updated
07/08/2007
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