Provider Demographics
NPI:1497373732
Name:ROBERTS, JOSHUA DEAN (OD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DEAN
Last Name:ROBERTS
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 1:256 W ANTELOPE DR APT D
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-6050
Mailing Address - Country:US
Mailing Address - Phone:435-213-0784
Mailing Address - Fax:
Practice Address - Street 1:460 N 325 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3578
Practice Address - Country:US
Practice Address - Phone:801-614-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11839138-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty