MEDICARE: ROCKY MOUNTAIN OPTICAL

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1467559492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN OPTICAL

Provider Business Mailing Address
First Line	:	4400 S 700 E
Second Line	:	STE 160
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3053
Country	:	US
Telephone Number	:	801-264-4430
Fax Number	:	801-264-4431

Provider Business Practice Location Address
First Line	:	4400 S 700 E
Second Line	:	STE 160
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3053
Country	:	US
Telephone Number	:	801-264-4430
Fax Number	:	801-264-4431

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. FRANKLIN REYNOLDS KNOWLTON
Credential	:	O.D.
Telephone Number	:	801-264-4406

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “ROCKY MOUNTAIN OPTICAL ” Practice Location

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