Provider Demographics
NPI:1386612919
Name:WOODFIELD, DALE A (OD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:WOODFIELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:492 W 3975 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1400
Mailing Address - Country:US
Mailing Address - Phone:801-621-0554
Mailing Address - Fax:801-392-6229
Practice Address - Street 1:5738 S 1475 E STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4860
Practice Address - Country:US
Practice Address - Phone:801-621-0554
Practice Address - Fax:801-392-6229
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111847-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005802401Medicare ID - Type Unspecified
UTT78172Medicare UPIN