Healthcare Provider Details

I. General information

NPI: 1790348449
Provider Name (Legal Business Name): SUMMIT EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 S 900 E STE 200
MIDVALE UT
84047-6067
US

IV. Provider business mailing address

7456 S PARKRIDGE CIR
COTTONWOOD HEIGHTS UT
84121-4834
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-6151
  • Fax: 801-999-7552
Mailing address:
  • Phone: 801-878-6151
  • Fax: 801-999-7552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRITTANY N. CAPSTICK
Title or Position: DR.
Credential: OD
Phone: 612-308-0679