Provider Demographics
NPI:1073786505
Name:FRANK A SIDDOWAY OD PC
Entity Type:Organization
Organization Name:FRANK A SIDDOWAY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-374-2227
Mailing Address - Street 1:1675 N 200 W
Mailing Address - Street 2:#11-A
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2540
Mailing Address - Country:US
Mailing Address - Phone:801-374-2227
Mailing Address - Fax:801-374-5197
Practice Address - Street 1:1675 N 200 W
Practice Address - Street 2:#11-A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2540
Practice Address - Country:US
Practice Address - Phone:801-374-2227
Practice Address - Fax:801-374-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1125699934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529902626008Medicaid
UT529902626008Medicaid
UTDF0721Medicare PIN