DR. Kevin Mark Ellsworth, O.D.

NPI #1669457024 in Logan, Utah

Provider Information

NPI Number: 1669457024
Entity Type: Individual
Name: DR. Kevin Mark Ellsworth, O.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Optometrist
Credential: O.D.
Enumeration Date: Dec 8, 2005
Last Updated: Aug 20, 2008

Practice Location

Address: 395 E 1400 N
Address 2: SUITE B
City: Logan
State: Utah
ZIP Code: 84341-7573
Phone: (435) 752-5585

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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