Active NPI
Spencer David Mortensen, O.D, F.A.A.O.
- Optometrist
- Salt Lake City, UT
National Provider Identifier
1548321078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 109072-9934
- Practice address
- 462 E 100 S
Salt Lake City, UT 84111-1802 - Phone
- (801) 532-5176
- Fax
- (801) 532-5179
- NPI assigned
- Dec 12, 2006
- Last updated
- Nov 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 109072-9934 | UT | Primary |
Addresses
Primary practice location
462 E 100 S
Salt Lake City, UT 84111-1802
Mailing address
462 E 100 S
Salt Lake City, UT 84111-1802
Phone (801) 532-5176
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | smortensen64050@direct.med.utah.edu | Direct | UNIVERSITY OF UTAH |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Precision Eye Care PLLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Eyewear Supplier
- Murray, UT
- NPI 1386750263
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1548321078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "462 E 100 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841111802",
"telephone_number": "801-532-5176",
"fax_number": "801-532-5179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "462 E 100 S",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841111802",
"telephone_number": "801-532-5176",
"fax_number": "801-532-5179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "SPENCER",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "O.D, F.A.A.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "UT",
"license": "109072-9934",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "smortensen64050@direct.med.utah.edu",
"affiliation": "Y",
"affiliationName": "UNIVERSITY OF UTAH",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/CCD/TXT",
"address_1": "50 N Medical Dr",
"city": "Salt Lake City",
"state": "UT",
"country_code": "US",
"postal_code": "841320001",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.