Provider Demographics
NPI:1841575438
Name:JASON P. BEHUNIN O.D. P.C.
Entity Type:Organization
Organization Name:JASON P. BEHUNIN O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:BEHUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-802-7101
Mailing Address - Street 1:1355 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7307
Mailing Address - Country:US
Mailing Address - Phone:801-802-7101
Mailing Address - Fax:801-802-7114
Practice Address - Street 1:1355 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7307
Practice Address - Country:US
Practice Address - Phone:801-802-7101
Practice Address - Fax:801-802-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5139706-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTV04359Medicare UPIN
UT000012737Medicare PIN