Provider Demographics
NPI:1235107434
Name:DORIUS, MICHAEL C (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:DORIUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S 850 W
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3214
Mailing Address - Country:US
Mailing Address - Phone:435-635-7766
Mailing Address - Fax:435-635-9128
Practice Address - Street 1:20 S 850 W
Practice Address - Street 2:SUITE 3
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-3214
Practice Address - Country:US
Practice Address - Phone:435-635-7766
Practice Address - Fax:435-635-9128
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5343436-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU95849Medicare UPIN
UT005776001Medicare ID - Type Unspecified