Provider Demographics
NPI:1659559979
Name:KEITH W. LINFORD OD PC
Entity Type:Organization
Organization Name:KEITH W. LINFORD OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:LINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-390-5153
Mailing Address - Street 1:4360 S WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-390-5153
Mailing Address - Fax:801-476-0067
Practice Address - Street 1:4360 S WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-390-5153
Practice Address - Fax:801-476-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1096749934332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1275512493OtherKEITH W. LINFORD OD (INDIVIDUAL) NPI
UT529662284007Medicaid
UT529662284OtherKEITH W. LINFORD OD (SS# )
UT1275512493OtherKEITH W. LINFORD OD (INDIVIDUAL) NPI
UT0776760001Medicare NSC