Most Relevant Information
Provider Data
| NPI Number: | 1003818576 |
| Provider Name: | RYAN J MORTENSEN O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | 5898711-9934 |
Most Important Dates
| Enumeration Date: | 08/12/2005 |
| Last Updated: | 01/07/2016 |
Provider Practice Location
11506 S DISTRICT DR
STE 400
SOUTH JORDAN
UT
840955769
Practice Location Phone/Fax
| Phone: | 8014954833 |
| Fax: | 8014954836 |
Provider Mailing Location
11506 S DISTRICT DR
STE 400
SOUTH JORDAN
UT
840955769
Provider Mailing Phone/Fax
| Phone: | 8014954833 |
| Fax: | 8014954836 |