Provider Demographics
NPI:1821663675
Name:HAWKS, DAXTON AARON (OD, MBA)
Entity Type:Individual
Prefix:
First Name:DAXTON
Middle Name:AARON
Last Name:HAWKS
Suffix:
Gender:M
Credentials:OD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 W 10 S
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-6253
Mailing Address - Country:US
Mailing Address - Phone:801-717-5655
Mailing Address - Fax:
Practice Address - Street 1:13126 S EAGLES FLIGHT RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-1410
Practice Address - Country:US
Practice Address - Phone:386-832-1112
Practice Address - Fax:801-477-8359
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12308049-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist