Provider Demographics
NPI:1215095245
Name:KNOWLTON, FRANKLIN R (OD,PLLC)
Entity type:Individual
Prefix:MR
First Name:FRANKLIN
Middle Name:R
Last Name:KNOWLTON
Suffix:
Gender:M
Credentials:OD,PLLC
Other - Prefix:MR
Other - First Name:F
Other - Middle Name:RENNY
Other - Last Name:KNOWLTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:195 E GENTILE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3754
Mailing Address - Country:US
Mailing Address - Phone:801-546-2020
Mailing Address - Fax:801-546-1237
Practice Address - Street 1:195 E GENTILE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3754
Practice Address - Country:US
Practice Address - Phone:801-546-2020
Practice Address - Fax:801-546-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1089469934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1184917734Medicaid
UTU00007376Medicare PIN