Jaime Michelle Etterling, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

12306522-9934 Issued in UT

Practice address

1140 E Brickyard Rd Ste 23
Salt Lake City, UT 84106-2557

Phone

(801) 530-6628

NPI assigned

May 24, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621814400000",
    "number": "1467027201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6936 ELM CREEK CT",
            "city": "LIBERTY TWP",
            "state": "OH",
            "postal_code": "450449225",
            "telephone_number": "513-910-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 E BRICKYARD RD STE 23",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062557",
            "telephone_number": "801-530-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTERLING",
        "first_name": "JAIME",
        "middle_name": "MICHELLE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "12306522-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl A Ethington, LSAC
• Daniel Ethington
• Kenneth Tillman Ethington Jr., PTA
• Meredith Ethington
• Bruce Dennis Etringer, PH.D.
• Mary Cornelius Etuk
• Eudemonia Space
• Matthew Euler, PHD
• Lexie Eusebio
• Eva Carlston Academy

• Optometrist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.