Provider Demographics
NPI:1255392569
Name:SATTERFIELD, DOUGLAS STEWART (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STEWART
Last Name:SATTERFIELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 S 1045 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5852
Mailing Address - Country:US
Mailing Address - Phone:801-765-4569
Mailing Address - Fax:
Practice Address - Street 1:575 UNIVERSITY PKWY
Practice Address - Street 2:UNIVERSITY MALL H-155
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7400
Practice Address - Country:US
Practice Address - Phone:801-225-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT729-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000067322Medicare PIN
UT064481Medicare UPIN
UT000090554Medicare ID - Type Unspecified