Provider Demographics
NPI:1255412771
Name:MUMFORD, TODD W (OD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:MUMFORD
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 1:1741 N 2000 W
Mailing Address - Street 2:
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-9810
Mailing Address - Country:US
Mailing Address - Phone:801-731-5558
Mailing Address - Fax:
Practice Address - Street 1:1741 N 2000 W
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-9810
Practice Address - Country:US
Practice Address - Phone:017-315-5558
Practice Address - Fax:801-731-3143
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5641152W00000X
UT8141255-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist