Provider Demographics
NPI:1417262122
Name:DAVID K. MORRILL O D P C
Entity Type:Organization
Organization Name:DAVID K. MORRILL O D P C
Other - Org Name:OQUIRRH MOUNTAIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:435-882-8439
Mailing Address - Street 1:102 W 1180 N STE 2
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1492
Mailing Address - Country:US
Mailing Address - Phone:435-882-8439
Mailing Address - Fax:
Practice Address - Street 1:102 W 1180 N STE 2
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-1492
Practice Address - Country:US
Practice Address - Phone:435-882-8439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284049-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1528085016Medicaid