Active NPI
David Jaeson Potter, OD
- Optometrist
- Midvale, UT
National Provider Identifier
1376036186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9068966-9934
- Practice address
- 20 W 7200 S
Midvale, UT 84047-3723 - Phone
- (801) 561-1300
- NPI assigned
- Jun 7, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 9068966-9934 | UT | Primary |
Addresses
Primary practice location
20 W 7200 S
Midvale, UT 84047-3723
Mailing address
10464 S Jordan Gtwy Unit 477
South Jordan, UT 84095-5409
Phone (435) 650-5579
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9068966-9934 | UT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| America's Best Contacts & Eyeglasses | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optician
- Midvale, UT
- NPI 1205868759
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1376036186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10464 S JORDAN GTWY UNIT 477",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840955409",
"telephone_number": "435-650-5579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 W 7200 S",
"city": "MIDVALE",
"state": "UT",
"postal_code": "840473723",
"telephone_number": "801-561-1300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "DAVID",
"middle_name": "JAESON",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-07",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "UT",
"license": "9068966-9934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midvale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.