Active NPI
Jeffrey Stancliffe, OD
- Optometrist
- Logan, UT
National Provider Identifier
1760059950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12298518-9934
- Practice address
- 1050 N Main St Ste 120
Logan, UT 84341-2483 - Phone
- (435) 514-6203
- NPI assigned
- Jun 7, 2021
- Last updated
- Jun 7, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 12298518-9934 | UT | Primary |
Addresses
Primary practice location
1050 N Main St Ste 120
Logan, UT 84341-2483
Mailing address
1078 E 13590 S
Draper, UT 84020-9790
Phone (504) 717-3701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12298518-9934 | UT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| National Vision Inc | Optometrist | Current | Accepting new patients |
Locations
1050 N Main St
Ste 120
Logan, UT 84341
Phone (435) 514-6203
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1760059950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1078 E 13590 S",
"city": "DRAPER",
"state": "UT",
"postal_code": "840209790",
"telephone_number": "504-717-3701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 N MAIN ST STE 120",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412483",
"telephone_number": "435-514-6203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANCLIFFE",
"first_name": "JEFFREY",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-07",
"last_updated": "2021-06-07",
"certification_date": "2021-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "UT",
"license": "12298518-9934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.