Provider Demographics
NPI:1629716170
Name:HUNSAKER, TAYLOR WENDELL (OD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:WENDELL
Last Name:HUNSAKER
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 1:3300 MAIN ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-3231
Mailing Address - Country:US
Mailing Address - Phone:801-628-1455
Mailing Address - Fax:
Practice Address - Street 1:1449 N 1400 W STE 24
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5237
Practice Address - Country:US
Practice Address - Phone:435-656-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12868110-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist