Provider Demographics
NPI:1740255058
Name:ESPLIN, DAVID J (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:ESPLIN
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:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-0267
Mailing Address - Country:US
Mailing Address - Phone:801-794-3937
Mailing Address - Fax:801-794-9880
Practice Address - Street 1:59 S 400 W
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2053
Practice Address - Country:US
Practice Address - Phone:801-794-3937
Practice Address - Fax:801-794-9880
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56790148908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52835513001Medicaid
UT52835513001Medicaid