Provider Demographics
NPI:1508020363
Name:PASSEY, CALLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:CALLIN
Middle Name:
Last Name:PASSEY
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 1:517 W 100 N STE 210
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9826
Mailing Address - Country:US
Mailing Address - Phone:435-755-6061
Mailing Address - Fax:994-836-2509
Practice Address - Street 1:517 W 100 N STE 110
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9826
Practice Address - Country:US
Practice Address - Phone:435-755-6075
Practice Address - Fax:435-374-0502
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5199756-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2046786Medicaid
WA344677OtherDEPT. OF LABOR & INDUSTRIES