Provider Demographics
NPI:1639357593
Name:DAVID R MASIHDAS ODPC
Entity Type:Organization
Organization Name:DAVID R MASIHDAS ODPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASIHDAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:801-363-2851
Mailing Address - Street 1:150 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1443
Mailing Address - Country:US
Mailing Address - Phone:801-363-2851
Mailing Address - Fax:801-363-7186
Practice Address - Street 1:150 S 1000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1443
Practice Address - Country:US
Practice Address - Phone:801-363-2851
Practice Address - Fax:801-363-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110793934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty