Jerald T Jolley, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2774059934 Issued in UT

Practice address

635 E 400 S
Salt Lake City, UT 84102-2803

Phone

(801) 531-7513

Fax

(801) 257-0399

NPI assigned

Jun 29, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Visionworks, Inc.

  dba Visionworks

  • Optometrist
  • Salt Lake City, UT
  • NPI 1649203381
  Medicare reassignment
• Riverton Family Eye Care Optometry Practice , LLC

  dba Riverton Family Eye Care LLC

  • Optometrist
  • Riverton, UT
  • NPI 1336349380
  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538197330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "SUITE 6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6663",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 E 400 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841022803",
            "telephone_number": "801-531-7513",
            "fax_number": "801-257-0399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLEY",
        "first_name": "JERALD",
        "middle_name": "T",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "2774059934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ariel Jolley
• Benjamin Dean Jolley, PHARMD
• Chad Jolley, PHARM D
• Elisabeth K. Jolley, MSW, LCSW
• Hailie Sandra Jolley
• Leo Dean Jolley, RPH
• Matthew Bryce Jolley, PHARMD
• Michelle Ann Jolley
• Trevor Jolley
• Jolley's Corner Businesses LLC (Jolleys Corner Pharmacy)

• 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 Jul 8, 2007; 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.