Provider Demographics
NPI:1558489039
Name:DASIE ENTERPRISES, INC.
Entity type:Organization
Organization Name:DASIE ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDLEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-361-0143
Mailing Address - Street 1:770 E MAIN ST
Mailing Address - Street 2:SUITE #133
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2284
Mailing Address - Country:US
Mailing Address - Phone:801-361-0143
Mailing Address - Fax:801-852-2841
Practice Address - Street 1:SEARS OPTICAL
Practice Address - Street 2:7453 S. PLAZA CTR. DR.
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-282-1261
Practice Address - Fax:801-282-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109764-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty