Provider Demographics
NPI:1932360690
Name:POULTER, WILLIAM CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CRAIG
Last Name:POULTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:7555 CENTER VIEW CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1970
Mailing Address - Country:US
Mailing Address - Phone:801-566-5683
Mailing Address - Fax:801-255-8371
Practice Address - Street 1:7555 CENTER VIEW CT
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1970
Practice Address - Country:US
Practice Address - Phone:801-566-5683
Practice Address - Fax:801-255-8371
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7044328-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist