Provider Demographics
NPI:1821643982
Name:STCLAIR, AUBRI ANN (ABOC)
Entity Type:Individual
Prefix:
First Name:AUBRI
Middle Name:ANN
Last Name:STCLAIR
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 E WADDELL ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4239
Mailing Address - Country:US
Mailing Address - Phone:801-901-0911
Mailing Address - Fax:801-206-2950
Practice Address - Street 1:1036 E WADDELL ST
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-4239
Practice Address - Country:US
Practice Address - Phone:801-901-0911
Practice Address - Fax:801-206-2950
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY161061156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician