NPIMap

Organization Active NPI

Department of Ophthalmology - Pediatric Division

  • Ophthalmology Physician
  • Salt Lake City, UT
National Provider Identifier
1467497156
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
DEPARTMENT OF OPHTHALMOLOGY - PEDIATRIC DIVISION
Practice address
100 Mario Capecchi Dr
# 3650
Salt Lake City, UT 84112-8924
Phone
(801) 581-3195
NPI assigned
Jun 18, 2006
Last updated
Sep 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Authorized official

Name
Randall J Olson, MDNPI 1518057132
Title
Department Chair
Phone
(801) 581-3195

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Pediatric Optometrist 152WP0200X
Contact Lens Technician/Technologist 156FC0800X
Contact Lens Fitter 156FC0801X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

100 Mario Capecchi Dr
# 3650
Salt Lake City, UT 84112-8924

Mailing address

65 Mario Capecchi Dr
Salt Lake City, UT 84132-0001
Phone (801) 581-3195

Other identifiers 3

IdentifierTypeStateIssuer
122451400OtherWYWYOMING MEDICAID
806964900OtherIDIDAHO MEDICAID
100503637OtherNVNEVADA MEDICAID

National Provider Directory

National Provider Directory

Locations

100 N Mario Capecchi Dr
#3650
Salt Lake City, UT 84113
Phone (801) 581-3195

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1467497156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MARIO CAPECCHI DR",
            "address_2": "# 3650",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841128924",
            "telephone_number": "801-581-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF OPHTHALMOLOGY - PEDIATRIC DIVISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR",
        "authorized_official_telephone_number": "801-581-3195",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FC0800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FC0801X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WYOMING MEDICAID",
            "identifier": "122451400",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO MEDICAID",
            "identifier": "806964900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA MEDICAID",
            "identifier": "100503637",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.