Individual provider Active NPI

Jason Mackay, OD

  • Optometrist
  • Draper, UT
National Provider Identifier
1821525965
Registry record updated Mar 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10650496-9934 Issued in UT
Practice address
1147 E Draper Pkwy
Draper, UT 84020-9096
Phone
(801) 916-9555
NPI assigned
May 19, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Optometrist 152WP0200X 10650496-9934 UT
Sports Vision Optometrist 152WS0006X 10650496-9934 UT
Vision Therapy Optometrist 152WV0400X 10650496-9934 UT
Optometrist 152W00000X 10650496-9934 UT Primary

Addresses

Primary practice location

1147 E Draper Pkwy
Draper, UT 84020-9096

Mailing address

1147 E Draper Pkwy
Draper, UT 84020-9096
Phone (714) 334-1664

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180320001820 UT Practitioner - Optometry 4183982317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1147 E Draper Pkwy
Draper, UT 84020-9096
Phone (801) 619-9555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33820CAMDChiropractor
10650496-9934UTMDSports Vision Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Hidden Valley Eyecare and Framed Optical, PLLC Optometrist CurrentSince Mar 7, 2018 Accepting new patients
Hidden Valley Eye Care, Inc. CurrentSince Mar 7, 2018 Accepting new patients

Locations

1147 E Draper Pkwy
Draper, UT 84020
Phone (714) 334-1664

Organizations & group practices 2

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": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1821525965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 E DRAPER PKWY",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209096",
            "telephone_number": "714-334-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 E DRAPER PKWY",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209096",
            "telephone_number": "801-916-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKAY",
        "first_name": "JASON",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-19",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "UT",
            "license": "10650496-9934",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "",
            "desc": "Optometrist, Sports Vision",
            "state": "UT",
            "license": "10650496-9934",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "UT",
            "license": "10650496-9934",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "10650496-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Draper, UT

Sources for this page

Verify at the official NPI Registry.