NPIMap

Organization Active NPI

Optometric Physician LLC

  • Optometrist
  • Highland, UT
National Provider Identifier
1700087335
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
375345-9934 Issued in UT
Legal business name
OPTOMETRIC PHYSICIAN LLC
Practice address
5455 W 11000 N
Suite 101
Highland, UT 84003-8800
Phone
(801) 756-9357
Fax
(801) 756-9358
NPI assigned
May 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kevin Jay Fromm, O.D.
Title
Manager
Phone
(801) 756-9357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 375345-9934 UT Primary

Addresses

Primary practice location

5455 W 11000 N
Suite 101
Highland, UT 84003-8800

Mailing address

5455 W 11000 N
Suite 101
Highland, UT 84003-8800
Phone (801) 756-9357

Other names 1

  • Highland Office Sub-Part Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050912000221 UT Part B Supplier - Clinic/Group Practice 3971536988 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pleasant Grove, UT; Highland, UT

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Optometric Physicians LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5457 W 11000 N
Ste 120
Highland, UT 84003

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700087335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 W 11000 N",
            "address_2": "SUITE 101",
            "city": "HIGHLAND",
            "state": "UT",
            "postal_code": "840038800",
            "telephone_number": "801-756-9357",
            "fax_number": "801-756-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5455 W 11000 N",
            "address_2": "SUITE 101",
            "city": "HIGHLAND",
            "state": "UT",
            "postal_code": "840038800",
            "telephone_number": "801-756-9357",
            "fax_number": "801-756-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC PHYSICIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FROMM",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "801-756-9357",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "UT",
            "license": "375345-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Highland Office Sub-Part",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Highland, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.