MEDICARE: DR. ANDREW PERRY ROCKWOOD 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	59500478908	UT

General Provider Information

NPI Number	:	1487641213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW PERRY ROCKWOOD O.D.

Provider Business Mailing Address
First Line	:	315 W WEBER HIGH DR
Second Line	:
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84414-1456
Country	:	US
Telephone Number	:	801-694-7243
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 E 2600 N
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-2278
Country	:	US
Telephone Number	:	801-701-7836
Fax Number	:	888-843-0491

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	11/12/2016

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