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General NPI Number Information
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NPI Number | 1053473785
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Entity Type | Individual
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Provider Name | RITA KARTINI DRUMMOND O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 12/29/2024
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Provider Practice Location Address
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Address Line | 2700 HOMESTEAD RD STE 30
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City | PARK CITY
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State | UT
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Zip | 84098-4874
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Country | US
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Telephone | 435-615-0435
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 HOMESTEAD RD STE 30
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City | PARK CITY
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State | UT
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Zip | 84098-4874
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Country | US
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Telephone | 435-615-0435
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Fax | 435-658-3094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11058TPG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13396954-9934
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License Number State | UT
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