=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023071214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER MARK TROXEL O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3620 W 3500 S
-----------------------------------------------------
City | WEST VALLEY CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84120-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-966-9975
-----------------------------------------------------
Fax | 801-963-3900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1099 E 5690 S
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84121-1072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-904-3417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4759525-9934
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------