Healthcare Provider Details

I. General information

NPI: 1336349380
Provider Name (Legal Business Name): RIVERTON FAMILY EYE CARE OPTOMETRY PRACTICE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2998 W 12600 S
RIVERTON UT
84065-7164
US

IV. Provider business mailing address

2998 W 12600 S
RIVERTON UT
84065-7164
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-7600
  • Fax: 801-446-0912
Mailing address:
  • Phone: 801-446-7600
  • Fax: 801-446-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberE66160
License Number StateUT

VIII. Authorized Official

Name: DR. JODIE J JOHNSON
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 801-446-7600