NPIMap

Organization Active NPI

Department of Ophthalmology

  • Ophthalmology Physician
  • Salt Lake City, UT
National Provider Identifier
1851327415
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
DEPARTMENT OF OPHTHALMOLOGY
Practice address
65 Mario Capecchi Dr
Salt Lake City, UT 84132-0001
Phone
(801) 581-3195
NPI assigned
Jun 24, 2006
Last updated
Apr 10, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

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

Authorized official

Name
Randall J Olson, MDNPI 1518057132
Title
Department Chair
Phone
(801) 581-3195

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Pediatric Optometrist 152WP0200X
Contact Lens Technician/Technologist 156FC0800X
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

65 Mario Capecchi Dr
Salt Lake City, UT 84132-0001

Mailing address

PO Box 413075
Salt Lake City, UT 84141-3075
Phone (801) 581-3195

Other identifiers 3

IdentifierTypeStateIssuer
100503634OtherNVNEVADA MEDICAID
122455700OtherWYWYOMING MEDICAID
805078300OtherIDIDAHO MEDICAID

National Provider Directory

National Provider Directory

Locations

6360 S 3000 E
Ste 200
Salt Lake City, UT 84121
Phone (801) 585-3937

1002 E South Temple
Ste 308
Salt Lake Cty, UT 84102
Phone (801) 363-3355

Practitioners & affiliated clinicians

Practitioners 10

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397088000000",
    "number": "1851327415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 413075",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841413075",
            "telephone_number": "801-581-3195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 MARIO CAPECCHI DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-3195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF OPHTHALMOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2014-04-10",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR",
        "authorized_official_telephone_number": "801-581-3195",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FC0800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Contact Lens",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA MEDICAID",
            "identifier": "100503634",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WYOMING MEDICAID",
            "identifier": "122455700",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO MEDICAID",
            "identifier": "805078300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.