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NPI Code Detail

MEDICARE: RETINA ASSOCIATES OF UTAH, P.C.

MEDICARE: RETINA ASSOCIATES OF UTAH, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology PhysicianUT
2207W00000XOphthalmology Physician
3207WX0107XRetina Specialist (Ophthalmology) Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CS8665OTHERRAILROAD MEDICARE

General Provider Information

NPI Number : 1396867214
Entity Type Code : Organization
Provider Name (Legal Business Name) : RETINA ASSOCIATES OF UTAH, P.C.
Provider Business Mailing Address
First Line : 5169 COTTONWOOD ST STE 630
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-6771
Country : US
Telephone Number : 801-281-3030
Fax Number : 801-281-3033
Provider Business Practice Location Address
First Line : 5169 COTTONWOOD ST STE 630
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84107-6771
Country : US
Telephone Number : 801-281-3030
Fax Number : 801-281-3033
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MS. DEBBIE G WILKINSON
Credential :
Telephone Number : 801-312-2010
Provider Enumeration Date : 04/03/2007
Last Update Date : 02/05/2018

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