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General NPI Number Information
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NPI Number | 1710980354
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN RETINA CONSULTANTS
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 4400 S 700 E STE 200
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-3000
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Country | US
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Telephone | 801-264-4444
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Fax | 801-281-2383
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Provider Business Mailing Address
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Address Line | 4400 S 700 E STE 200
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-3000
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Country | US
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Telephone | 801-264-4444
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Fax | 801-281-2383
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MINDY THORNE
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Credential |
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Telephone | 801-264-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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