Provider Demographics
NPI:1134390255
Name:KENNETH E HOOTON, O.D.
Entity type:Organization
Organization Name:KENNETH E HOOTON, O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOOTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-756-4731
Mailing Address - Street 1:60 S 200 E
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2412
Mailing Address - Country:US
Mailing Address - Phone:801-756-4731
Mailing Address - Fax:801-756-5865
Practice Address - Street 1:60 S 200 E
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2412
Practice Address - Country:US
Practice Address - Phone:801-756-4731
Practice Address - Fax:801-756-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91-109607-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0526050001Medicare NSC