MEDICARE: CHRISTOPHER MARK TROXEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4759525-9934	UT

General Provider Information

NPI Number	:	1023071214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MARK TROXEL O.D.

Provider Business Mailing Address
First Line	:	1099 E 5690 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1072
Country	:	US
Telephone Number	:	801-904-3417
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-3302
Country	:	US
Telephone Number	:	801-966-9975
Fax Number	:	801-963-3900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2006
Last Update Date	:	07/08/2007

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