Healthcare Provider Details

I. General information

NPI: 1255727905
Provider Name (Legal Business Name): CHRISTOPHER RICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 11/27/2023
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 N STATE ST
PROVO UT
84604-1010
US

IV. Provider business mailing address

1735 N STATE ST
PROVO UT
84604-1010
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-1818
  • Fax: 801-374-0163
Mailing address:
  • Phone: 801-374-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1014225-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: