Healthcare Provider Details

I. General information

NPI: 1912202425
Provider Name (Legal Business Name): OLYMPUS EYE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5872 S 900 E STE 100
MURRAY UT
84121-1677
US

IV. Provider business mailing address

5872 S 900 E STE 100
MURRAY UT
84121-1677
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-0726
  • Fax: 801-262-2838
Mailing address:
  • Phone: 801-261-0726
  • Fax: 801-262-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7871004-0144
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID WILLIAM DODDS
Title or Position: OWNER
Credential: M.D.
Phone: 801-261-0726