Provider Demographics
NPI:1538804968
Name:GENERALHEALTHGROUP OF UTAH
Entity type:Organization
Organization Name:GENERALHEALTHGROUP OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASIHDAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-789-5058
Mailing Address - Street 1:244 5TH AVE # L270
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7604
Mailing Address - Country:US
Mailing Address - Phone:917-789-5058
Mailing Address - Fax:
Practice Address - Street 1:150 S 1000 E
Practice Address - Street 2:STE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-363-2851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERALHEALTH GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty