Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

DR. KEVIN MARK ELLSWORTH, O.D.

Active Sole Proprietor

DR. KEVIN MARK ELLSWORTH, O.D. is a Optometrist healthcare provider located in LOGAN, Utah. NPI 1669457024 is currently active in the NPPES registry. Verify at CMS.

Optometrist · LOGAN, UT

Registration Details

NPI Number: 1669457024
Provider Type: Individual
Gender: Male
NPI Issued: Dec 8, 2005 (20.639455163904 yrs)
Last Updated: Aug 20, 2008
License: 112376-9934 (UT)
Sole Proprietor: Yes

Practice Information

Address: 395 E 1400 N

SUITE B

LOGAN, UT, 843417573
Browse UT providers · Browse ZIP 84341
Phone: 4357525585
Fax: 4357872871
Primary Specialty: Optometrist
152W00000X

Other Optometrist Providers in LOGAN, UT

Name	Credential	NPI
DR. GUSTAF ISAAC GIBSON	O.D.	1215917307
DR. ALAN HASTINGS	O.D.	1679523245
JEFFREY L CROMWELL	O.D.	1801902333
DR. MATTHEW DALE PARRY	O.D.	1639256670
DR. JEFF H SEEHOLZER	O.D	1326196569
REBECCA LYNN FREEMAN	O.D.	1174789721

Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.