=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659609279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 20-20 EYECARE OF UTAH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2009
-----------------------------------------------------
Last Update Date | 11/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3544 W 6200 S UNIT #104
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84118-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-966-2020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 373 BRAMBLEBERRY LN
-----------------------------------------------------
City | DRAPER
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84020-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-619-8067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. RONALD SCOTT ROPER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 801-966-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 51898809934
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------