Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4764729-9934 | UT |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4764729-8904 | UT |
NPI | 1295753465 |
---|---|
Provider Name | Dr. John Hawes Ackerson |
First Address | Heber City, UT 84032-3739 |
Second Address | Heber City, UT 84032-3739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 24/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D5280 | (05) | UT |
U82846 | (02) | UT |