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General NPI Number Information
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NPI Number | 1952652273
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF OPHTHALMOLOGY
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 5126 W DAYBREAK PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5994
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Country | US
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Telephone | 801-213-4500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 413075
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City | SALT LAKE CITY
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State | UT
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Zip | 84141-3075
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Country | US
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Telephone | 801-213-3900
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Fax |
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Authorized Official
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Title or Position | DEPARTMENT CHAIR
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Name | RANDALL J OLSON
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Credential | MD
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Telephone | 801-587-6470
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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