Provider Demographics
NPI:1013970235
Name:ABUNDO, ROLAND ESPELETA (OD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:ESPELETA
Last Name:ABUNDO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:579 FORT UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2213
Mailing Address - Country:US
Mailing Address - Phone:801-255-8500
Mailing Address - Fax:801-255-2334
Practice Address - Street 1:579 FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2213
Practice Address - Country:US
Practice Address - Phone:801-255-8500
Practice Address - Fax:801-255-2334
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3097889934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist