MEDICARE: ROCKY MTN EYE CARE ASSOCIATES LC

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	261QS0132X	Ophthalmologic Surgery Clinic/Center

General Provider Information

NPI Number	:	1538163936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MTN EYE CARE ASSOCIATES LC

Provider Business Mailing Address
First Line	:	4400 S 700 E
Second Line	:	# 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-264-4450
Fax Number	:	801-264-4409

Provider Business Practice Location Address
First Line	:	4400 S 700 E
Second Line	:	# 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-264-4450
Fax Number	:	801-264-4409

Authorized Official
Title or Position	:	DR
Name	:	E. LEIGH WILKINSON
Credential	:	MD
Telephone Number	:	801-264-4450

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/15/2013

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