NPIMap

Organization Active NPI

Davis Vision Center Associates PLLC

  • Ophthalmology Physician
  • South Jordan, UT
National Provider Identifier
1689997165
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
172302-1205 Issued in UT
Legal business name
DAVIS VISION CENTER ASSOCIATES PLLC
Doing business as
Davis Vision Center
Practice address
1325 W South Jordan Pkwy
Suite 103
South Jordan, UT 84095-9060
Phone
(801) 253-3080
Fax
(801) 253-0772
NPI assigned
Mar 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Dr. Brian R Davis, MDNPI 1679583470
Title
Owner
Phone
(801) 253-3080

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 172302-1205 UT Primary

Addresses

Primary practice location

1325 W South Jordan Pkwy
Suite 103
South Jordan, UT 84095-9060

Mailing address

11649 South 4000 West
Suite 200
South Jordan, UT 84009-9060
Phone (201) 253-3080

Other names 1

  • Davis Vision Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100506000263 UT Part B Supplier - Clinic/Group Practice 0446388805 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: South Jordan, UT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3741 W 12600 S
Ste 480
Riverton, UT 84065
Phone (801) 285-2037

11649 S 4000 W
Ste 200
South Jordan, UT 84009
Phone (801) 253-3080

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1689997165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11649 SOUTH 4000 WEST",
            "address_2": "SUITE 200",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840099060",
            "telephone_number": "201-253-3080",
            "fax_number": "801-253-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 W SOUTH JORDAN PKWY",
            "address_2": "SUITE 103",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840959060",
            "telephone_number": "801-253-3080",
            "fax_number": "801-253-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS VISION CENTER ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-253-3080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "172302-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davis Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Davis Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.