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Personal Information
Profession: Contact Lens Distribution License
Address:
261 W Data Dr
Draper, UT, 84020
Phone: (801) 316 5502
Fax: (801) 316 5503
Year of Birth:
- School Name:
- Degree Date:
License Information
- License Number: 75-00001
- License Type: Active
- License Status: Current
- License Expiration Date: 10/02/2025
- Original License Date: 06/10/2003
- Last Renewal Date: 09/27/2024
- Date This Status: 10/06/2023
- Continuing Education Year:
- Temporary License Permit Number:
- Temporary License Permit Issue Date:
- Temporary License Permit Expiration Date:
Practice Specialty
Specialties and board certifications are for MDs and DOs only and are self-reported. Therefore, they are not independently verified by the Board of Healing Arts.
Other KSBHA Licenses
None Reported
Health Care Facility Privilege Actions
None Reported
Other Public License Actions, DEA Actions, Criminal Actions, or Miscellaneous Information
None Reported
Statement from Licensee or Registrant
None Reported
License Profile last updated: December 2, 2024