MEDICARE: U OF U ROCKY MOUNTAIN OPHTHALMOLOGY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	152WP0200X	Pediatric Optometrist
3	156FC0800X	Contact Lens Technician/Technologist
4	156FC0801X	Contact Lens Fitter
5	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831134519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U OF U ROCKY MOUNTAIN OPHTHALMOLOGY

Provider Business Mailing Address
First Line	:	4400 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-264-4464
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3000
Country	:	US
Telephone Number	:	801-264-4464
Fax Number	:

Authorized Official
Title or Position	:	DEPARTMENT CHAIR
Name	:	RANDALL J OLSON
Credential	:	MD
Telephone Number	:	801-581-3195

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	09/06/2011

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Directions to “U OF U ROCKY MOUNTAIN OPHTHALMOLOGY ” Practice Location

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