Provider Demographics
NPI:1851580773
Name:FELLOWS & MORTENSEN, LLC
Entity Type:Organization
Organization Name:FELLOWS & MORTENSEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-566-4119
Mailing Address - Street 1:9035 S 1300 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3131
Mailing Address - Country:US
Mailing Address - Phone:801-566-4119
Mailing Address - Fax:801-568-3844
Practice Address - Street 1:9035 S 1300 E STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3131
Practice Address - Country:US
Practice Address - Phone:801-566-4119
Practice Address - Fax:801-568-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5898711-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty