Healthcare Provider Details

I. General information

NPI: 1750373411
Provider Name (Legal Business Name): RICK W WINWARD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 S STATE ST
OREM UT
84097-7701
US

IV. Provider business mailing address

631 N 540 E
MAPLETON UT
84664-3773
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-8500
  • Fax:
Mailing address:
  • Phone: 801-491-9864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4944080-9934
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4944080-9934
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: