Healthcare Provider Details

I. General information

NPI: 1982146643
Provider Name (Legal Business Name): ROCKWOOD OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 11/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 2600 N
NORTH OGDEN UT
84414-2278
US

IV. Provider business mailing address

315 W WEBER HIGH DR
PLEASANT VIEW UT
84414-1456
US

V. Phone/Fax

Practice location:
  • Phone: 801-701-7836
  • Fax: 888-843-0491
Mailing address:
  • Phone: 801-694-7243
  • Fax: 888-843-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number59500478908
License Number StateUT

VIII. Authorized Official

Name: DR. ANDREW PERRY ROCKWOOD
Title or Position: OWNER
Credential: O.D.
Phone: 801-694-7243