Provider Demographics
NPI:1811992555
Name:TAYLOR, MARK A (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0792
Mailing Address - Country:US
Mailing Address - Phone:801-774-8707
Mailing Address - Fax:801-774-8784
Practice Address - Street 1:128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1951
Practice Address - Country:US
Practice Address - Phone:801-543-2525
Practice Address - Fax:801-593-1982
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345066-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT141851557OtherMAILHANDLERS
UT1472285OtherUNITED MINE WORKERS
UTGRP108096200Medicaid
UT349783OtherDESERET MUTUAL
UT570526286TA1OtherEDUCATORS MUTUAL
UT364806OtherUSA MANAGED CARE
UT141851887OtherPEHP
TX14237OtherRIO GRANDE
UT2068338OtherFIRST HEALTH
UT2200211OtherUNITED HEALTH CARE
UT141851557OtherTRICARE
UT005714101Medicare ID - Type Unspecified
UT141851557OtherMAILHANDLERS