Dept of Ophthalmology

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

DEPT OF OPHTHALMOLOGY

Practice address

65 Mario Capecchi Dr
Salt Lake City, UT 84132-0001

Phone

(801) 581-3195

NPI assigned

Sep 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randall Olson, M.D

Title

Department Chair

Phone

(801) 581-3195

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352246400000",
    "number": "1194910281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413075",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413075",
            "telephone_number": "801-581-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPT OF OPHTHALMOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2012-11-07",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR",
        "authorized_official_telephone_number": "801-581-3195",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.