Roosevelt Vision Clinic, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

111999-9934 Issued in UT

Legal business name

ROOSEVELT VISION CLINIC, PC

Practice address

165 W 200 N
71-7
Roosevelt, UT 84066-2834

Phone

(435) 722-2981

Fax

(435) 722-3732

NPI assigned

Sep 22, 2005

Last updated

Aug 27, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Scott H Kowallis, O.D.NPI 1861487050

Title

Owner/Doctor

Phone

(435) 722-2981

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 5

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.

• Jason Kowallis, OD

  • Optometrist
  • Roosevelt, UT
  • NPI 1942561311
  Medicare reassignment Care Compare group NPD
• Scott H Kowallis, O.D.

  • Optometrist
  • Roosevelt, UT
  • NPI 1861487050
  Medicare reassignment NPD Authorized official
• Jon Preston Wilson, O.D.

  • Optometrist
  • Roosevelt, UT
  • NPI 1760477731
  Medicare reassignment Care Compare group NPD
• Cade John Kowallis, O.D.

  • Optometrist
  • Nixa, MO
  • NPI 1952781262

  UT

  Medicare reassignment Care Compare group NPD
• David R Griffin, M.D.

  • Ophthalmology Physician
  • Pleasant Grove, UT
  • NPI 1023471901
  NPD (past)

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219795200000",
    "number": "1710973052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 W 200 N",
            "address_2": "71-7",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662834",
            "telephone_number": "435-722-2981",
            "fax_number": "435-722-3732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 W 200 N",
            "address_2": "71-7",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662834",
            "telephone_number": "435-722-2981",
            "fax_number": "435-722-3732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT VISION CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2008-08-27",
        "status": "A",
        "authorized_official_last_name": "KOWALLIS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "435-722-2981",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "111999-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristopher Scott Riser, FNP
• Robinson Dental & Implants
• Dan Ray Robinson, DMD
• Adam Rockwood, ATC
• Roosevelt Chiropractic, P.C.
• Salt Lake City Vamc
• Todd Scholes, PT
• Clark K Sessions, PA-C
• Kent E Smith, MD
• Samuel Smith, OTR/L

• Optometrist in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.