Healthcare Provider Details

I. General information

NPI: 1407160351
Provider Name (Legal Business Name): NADIA ROSHAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 S STATE ST STE 1312
SANDY UT
84070-3196
US

IV. Provider business mailing address

10450 S STATE ST STE 1312
SANDY UT
84070-3196
US

V. Phone/Fax

Practice location:
  • Phone: 801-901-3346
  • Fax: 801-901-3346
Mailing address:
  • Phone: 801-901-3346
  • Fax: 801-901-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number12248648
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: