SLC Walmart Eye Docs

Primary specialty

OptometristTaxonomy code 152W00000X

License

5354412-9934 Issued in UT

Legal business name

SLC WALMART EYE DOCS

Practice address

3590 W South Jordan Pkwy
South Jordan, UT 84095-8916

Phone

(801) 601-3131

NPI assigned

Feb 2, 2016

Organization subpart

No

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

Authorized official

Name

Michael Conklin, ODNPI 1013015650

Title

MBR/Optometrist

Phone

(801) 502-7394

Specialties & licenses 1

Addresses

Practitioners 1

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

• Michael D Conklin, O.D.

  • Optometrist
  • Salt Lake City, UT
  • NPI 1013015650
  NPD (past) Authorized official

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1346608619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9067 S BORDEAUX WAY",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840932216",
            "telephone_number": "801-502-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 W SOUTH JORDAN PKWY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958916",
            "telephone_number": "801-601-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLC WALMART EYE DOCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-02",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "CONKLIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MBR/OPTOMETRIST",
        "authorized_official_telephone_number": "801-502-7394",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "UT",
            "license": "5354412-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Sisk
• Elmer G Sisneros, PA
• SJ Oral Surgery PC
• Bryan Eugene Skiles, CMHC, LMHC
• Kosheila Slade
• Sleep Alternatives Salt Lake , LLC
• Sleep Institute of Utah LC
• Sleep Synergies, LLC
• Sleepwell Partner LLC
• Slickrock Ventures, LLC

• Optometrist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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.