MEDICARE: DR. NADIA ROSHAN OD

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
1	152WX0102X	Occupational Vision Optometrist	12248648	UT

General Provider Information

NPI Number	:	1407160351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADIA ROSHAN OD

Provider Business Mailing Address
First Line	:	10450 S STATE ST STE 1312
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3196
Country	:	US
Telephone Number	:	801-901-3346
Fax Number	:	801-901-3346

Provider Business Practice Location Address
First Line	:	10450 S STATE ST STE 1312
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3196
Country	:	US
Telephone Number	:	801-901-3346
Fax Number	:	801-901-3346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	02/11/2026

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