Roosevelt Vision Clinic, PC

NPI #1710973052 in Roosevelt, Utah

Provider Information

NPI Number: 1710973052
Entity Type: Organization
Organization Name: Roosevelt Vision Clinic, PC
Primary Specialty: Optometrist
Enumeration Date: Sep 22, 2005
Last Updated: Aug 27, 2008

Practice Location

Address: 165 W 200 N
Address 2: 71-7
City: Roosevelt
State: Utah
ZIP Code: 84066-2834
Phone: (435) 722-2981

Authorized Official

Name: SCOTT H KOWALLIS, O.D.
Title: OWNER/DOCTOR
Phone: (435) 722-2981

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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