Provider Demographics
NPI:1659384204
Name:DR. DALE A. WOODFIELD AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DR. DALE A. WOODFIELD AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOODFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-621-0554
Mailing Address - Street 1:492 W 3975 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1400
Mailing Address - Country:US
Mailing Address - Phone:801-689-3550
Mailing Address - Fax:801-392-1291
Practice Address - Street 1:3651 WALL AVE
Practice Address - Street 2:1226
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7110
Practice Address - Country:US
Practice Address - Phone:801-621-0554
Practice Address - Fax:801-392-1291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111847-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDD3972OtherGROUP RAILROAD MEDICARE
UT000058024Medicare ID - Type UnspecifiedGROUP NUMBER