| |
261 W. Data Dr., Draper, UT 84020-7942 | |
(801) 316-5508 | |
(801) 316-7529 |
Full Name | |
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Type | Facility |
Speciality | Eyewear Supplier |
Location | 261 W. Data Dr., Draper, Utah |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225373640 | NPI | - | NPPES |
Provider Name | Bruce T Childs |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1235194838 PECOS PAC ID: 5799779054 Enrollment ID: I20040412000359 |
Mailing Address | Practice Location Address |
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261 W. Data Dr., Draper, UT 84020-7942 Ph: (801) 316-5508 | 261 W. Data Dr., Draper, UT 84020-7942 Ph: (801) 316-5508 |