David D Mortensen, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

361378-9934 Issued in UT

Practice address

2028 W 2220 N
Clinton, UT 84015-5744

Phone

(801) 779-0708

Fax

(385) 393-7875

NPI assigned

Jun 28, 2005

Last updated

Oct 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in UT, TX2 enrollments

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 2

Specialty

Optometry

Education

Southern College of Optometry, 1998

Medicare assignment

May accept Medicare assignment

Group practices

Promontory Vision PartnersGroup PAC ID 3375602790, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Promontory Vision Partners

  dba Clinton Family Vision

  • Optometrist
  • Clinton, UT
  • NPI 1013187822
  Medicare reassignment Care Compare group
• Confederated Tribes of the Goshute Reservation

  • General Practice Physician
  • Ibapah, UT
  • NPI 1750510277

  Single Specialty, TX

  Medicare reassignment NPD
• David B. Burnett P.C.

  dba Oakridge Optometry

  • Optometrist
  • Farmington, UT
  • NPI 1669651808
  NPD (past)

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1871590430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 W 2220 N",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840155744",
            "telephone_number": "801-779-0708",
            "fax_number": "385-393-7875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2028 W 2220 N",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840155744",
            "telephone_number": "801-779-0708",
            "fax_number": "385-393-7875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSEN",
        "first_name": "DAVID",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0601800582",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "361378-9934",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003429 A & B",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "162686",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO RAILROAD MEDICAR",
            "identifier": "P00190241",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010118166",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ann Maruri, DNP, CPNP
• Joseph Karl McCombs, D.D.S.
• Gregory Scott Medved
• Scott L Mitchell
• Jenny Marie Morales, SLP
• Mountain View Medical, LLC
• Adriane Fox Murdock, OTR/L
• National Hearing Centers (Amplifon Hearing Aid Centers)
• National Vision Inc (America's Best)
• Kathleen Joanna Newton, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.