NPIMap

Organization Active NPI

CLR Vision PC

  • Optometrist
  • Provo, UT
National Provider Identifier
1235304064
Registry record updated Apr 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5950660-9943 Issued in UT
Legal business name
CLR VISION PC
Practice address
1675 N 200 W #11a
Provo, UT 84604-2570
Phone
(801) 374-2227
Fax
(801) 374-5197
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2008

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

Authorized official

Name
Dr. Chad L Rigtrup, ODNPI 1821109059
Title
Owner
Phone
(801) 374-2227

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 5950660-9943 UT Primary

Addresses

Primary practice location

1675 N 200 W #11a
Provo, UT 84604-2570

Mailing address

1675 N 200 W #11a
Provo, UT 84604-2570
Phone (801) 374-2227

Other identifiers 1

IdentifierTypeStateIssuer
461538993001MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080602000188 UT Part B Supplier - Clinic/Group Practice 8527099506 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Provo, UT; Springville, UT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
CLR Vision PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

262 E 400 S
Springville, UT 84663
Phone (801) 489-5166

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1235304064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 N 200 W #11A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042570",
            "telephone_number": "801-374-2227",
            "fax_number": "801-374-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 N 200 W #11A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042570",
            "telephone_number": "801-374-2227",
            "fax_number": "801-374-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLR VISION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "RIGTRUP",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-374-2227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "UT",
            "license": "5950660-9943",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "461538993001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.