Provider Demographics
NPI:1437129681
Name:JEPSEN, NOLAN (OD)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:
Last Name:JEPSEN
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 1:1580 W ANTELOPE DR
Mailing Address - Street 2:SUITE 1580
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1160
Mailing Address - Country:US
Mailing Address - Phone:801-773-2233
Mailing Address - Fax:801-773-2375
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:SUITE 1580
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:801-773-2233
Practice Address - Fax:801-773-2375
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98362600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU73244Medicare UPIN