Provider Demographics
NPI:1053412494
Name:DAYNES, TODD (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:DAYNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 S FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-3309
Mailing Address - Country:US
Mailing Address - Phone:801-296-2356
Mailing Address - Fax:
Practice Address - Street 1:520 MEDICAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4968
Practice Address - Country:US
Practice Address - Phone:801-294-8855
Practice Address - Fax:801-294-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5842999-1205207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT269929OtherALTIUS
UT107040091102OtherIHC
UTA001OtherTRICARE