Provider Demographics
NPI:1992483085
Name:MONSALVE-WARD, LEIDY DAYAN (OD)
Entity type:Individual
Prefix:DR
First Name:LEIDY
Middle Name:DAYAN
Last Name:MONSALVE-WARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LEIDY
Other - Middle Name:DAYAN
Other - Last Name:MONSALVE-WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4400 S 700 E
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3284
Mailing Address - Country:US
Mailing Address - Phone:801-264-4450
Mailing Address - Fax:
Practice Address - Street 1:4400 S 700 E STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3346
Practice Address - Country:US
Practice Address - Phone:801-264-4450
Practice Address - Fax:801-264-4409
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13485292-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist