NPIMap

Organization Active NPI

Eye Pros of Ogden

Doing business as Eye Pros

  • Optometrist
  • Riverdale, UT
National Provider Identifier
1710456975
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYE PROS OF OGDEN
Doing business as
Eye Pros
Practice address
4115 Riverdale Rd
Riverdale, UT 84405-3509
Phone
(208) 297-7019
NPI assigned
Nov 16, 2018
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
Lavar W Kofoed, ODNPI 1023231420
Title
Owner
Phone
(208) 297-7019

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
Optometrist 152W00000X Primary

Addresses

Primary practice location

4115 Riverdale Rd
Riverdale, UT 84405-3509

Mailing address

3485 N Cole Rd Unit 45479
Boise, ID 83711-1095
Phone (208) 297-7019

Other names 1

  • Eye Pros Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190110002752 UT Part B Supplier - Clinic/Group Practice 6901142025 Receives reassigned benefits from 8 practitioners
Practice locations: Riverdale, UT

National Provider Directory

National Provider Directory

Locations

4115 Riverdale Rd
Riverdale, UT 84405
Phone (208) 297-7019

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1542326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1710456975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N COLE RD UNIT 45479",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837111095",
            "telephone_number": "208-297-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 RIVERDALE RD",
            "city": "RIVERDALE",
            "state": "UT",
            "postal_code": "844053509",
            "telephone_number": "208-297-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE PROS OF OGDEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-16",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "KOFOED",
        "authorized_official_first_name": "LAVAR",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-297-7019",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eye Pros",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.