Provider Demographics
NPI:1821079989
Name:MASIHDAS, DAVID R (O D P C)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MASIHDAS
Suffix:
Gender:M
Credentials:O D P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 1000 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1496
Mailing Address - Country:US
Mailing Address - Phone:801-363-2851
Mailing Address - Fax:801-363-7186
Practice Address - Street 1:150 S 1000 E STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1496
Practice Address - Country:US
Practice Address - Phone:801-363-2851
Practice Address - Fax:801-363-7186
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1107939934152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00009702Medicare ID - Type Unspecified