NPIMap

Organization Active NPI

Layton Visual Center

  • Pediatric Optometrist
  • Layton, UT
National Provider Identifier
1366645954
Registry record updated Feb 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric OptometristTaxonomy code 152WP0200X
License
108553-8908 Issued in UT
Legal business name
LAYTON VISUAL CENTER
Practice address
180 West Gordon Ave
Layton, UT 84041
Phone
(801) 546-2481
Fax
(801) 546-2483
NPI assigned
Jun 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2013

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

Authorized official

Name
Mr. Denmark Ray Jensen, O.D.NPI 1538127170
Title
Owner
Phone
(801) 546-2481

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Low Vision Rehabilitation OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WL0500X 108553-8908 UT
Pediatric OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WP0200X 108553-8908 UT Primary
Sports Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WS0006X 108553-8908 UT
Occupational Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WX0102X 108553-8908 UT

Addresses

Primary practice location

180 West Gordon Ave
Layton, UT 84041

Mailing address

180 West Gordon Ave
Layton, UT 84041
Phone (801) 546-2481

Other identifiers 1

IdentifierTypeStateIssuer
529461401004MedicaidUT

Other names 1

  • Layton Visual Center, Inc Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816001268 UT Part B Supplier - Clinic/Group Practice 2163495342 Receives reassigned benefits from 2 practitioners
Practice locations: Layton, UT

National Provider Directory

National Provider Directory

Locations

180 W Gordon Ave
Ste E1
Layton, UT 84041
Phone (801) 546-2481

Practitioners & affiliated clinicians

Practitioners 2

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": "1181347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360713600000",
    "number": "1366645954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 WEST GORDON AVE",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "84041",
            "telephone_number": "801-546-2481",
            "fax_number": "801-546-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WEST GORDON AVE",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "84041",
            "telephone_number": "801-546-2481",
            "fax_number": "801-546-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAYTON VISUAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-09",
        "last_updated": "2013-02-13",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "DENMARK",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-546-2481",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "UT",
            "license": "108553-8908",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "UT",
            "license": "108553-8908",
            "primary": true
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "UT",
            "license": "108553-8908",
            "primary": false
        },
        {
            "code": "152WX0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Occupational Vision",
            "state": "UT",
            "license": "108553-8908",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529461401004",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Layton Visual Center, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Layton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; 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.