Provider Demographics
NPI:1669575833
Name:DR. COURTNEY SIVERTSON, P.C.
Entity type:Organization
Organization Name:DR. COURTNEY SIVERTSON, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SIVERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-471-1055
Mailing Address - Street 1:7915 CITORI DR
Mailing Address - Street 2:E102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0196
Mailing Address - Country:US
Mailing Address - Phone:801-471-1055
Mailing Address - Fax:
Practice Address - Street 1:7915 CITORI DR
Practice Address - Street 2:E102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0196
Practice Address - Country:US
Practice Address - Phone:801-471-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6246453-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty