Provider Demographics
NPI:1891799839
Name:GRIFFETH, MICHAEL TODD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:GRIFFETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 N 400 E STE 101
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3413
Mailing Address - Country:US
Mailing Address - Phone:435-843-8333
Mailing Address - Fax:435-843-8334
Practice Address - Street 1:2376 N 400 E STE 101
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3413
Practice Address - Country:US
Practice Address - Phone:435-843-8333
Practice Address - Fax:435-843-8334
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3089527-1205207W00000X, 332B00000X
IDM-8844207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010145834OtherBLUE SHIELD
UT1477588044Medicaid
ID806715901OtherMEDICAID
UT268347OtherALTIUS
UT53583OtherDAVIS VISION
UT107002804102OtherSELECTHEALTH
UTP00402102OtherRR MEDICARE
UT1818481OtherMAIL HANDLERS
UT1114281OtherCIGNA
UTQMP000003333246OtherMOLINA
UT1477588044OtherCLEARVUE NPI
UT203908830MJGOtherEDUCATORS MUTUAL
UT1477588044OtherCLEARVUE NPI
H14926Medicare UPIN
UT6011180001Medicare NSC
UT000060094Medicare PIN