Ashley Phan

Primary specialty

OptometristTaxonomy code 152W00000X

License

12322408-9934 Issued in UT

Practice address

11649 S 4000 W Ste 200
South Jordan, UT 84009-6048

Phone

(801) 253-3080

NPI assigned

May 3, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Davis Vision Center Associates PLLCGroup PAC ID 0446388805, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/imedicware_davisvisioncenter

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

• Davis Vision Center Associates PLLC

  • Ophthalmology Physician
  • South Jordan, UT
  • NPI 1689997165
  Medicare reassignment Care Compare group NPD
• Davis Vision Center

  • Ophthalmology Physician
  • South Jordan, UT
  • NPI 1215947023
  NPD (past)

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1700469236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 S 700 E # A",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841052102",
            "telephone_number": "972-333-3260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11649 S 4000 W STE 200",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096048",
            "telephone_number": "801-253-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "ASHLEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-03",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "12322408-9934",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10237T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mitchell Alan Peterson, MD
• Valerie Peterson
• Zoe Pettersson
• Devrie Pettit, MS, RDN
• Kendal Petty
• Physician Group of Utah Inc
• Physician Group of Utah Inc
• Piacitelli FM LLC
• Annliza Lachica Piacitelli, M.D.
• Thomas Wallace Pincock, CMHC

• Optometrist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.