Provider Demographics
NPI:1275569444
Name:HUMPHERYS, RICH H (OD)
Entity Type:Individual
Prefix:DR
First Name:RICH
Middle Name:H
Last Name:HUMPHERYS
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 1:1055 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3605
Mailing Address - Country:US
Mailing Address - Phone:801-394-5709
Mailing Address - Fax:801-394-5710
Practice Address - Street 1:1055 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3605
Practice Address - Country:US
Practice Address - Phone:801-394-5709
Practice Address - Fax:801-394-5710
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111347-8908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78164Medicare UPIN