NPIMap

Individual provider Active NPI

Stephen Nicholas Lundquist, OD

  • Optometrist
  • Salt Lake City, UT
National Provider Identifier
1891216909
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11046583-9934 Issued in UT
Practice address
801 S 800 E
Salt Lake City, UT 84102-3515
Phone
(801) 819-9084
NPI assigned
Jun 28, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CA
Optometrist 152W00000X 11046583-9934 UT Primary

Addresses

Primary practice location

801 S 800 E
Salt Lake City, UT 84102-3515

Mailing address

801 S 800 E
Salt Lake City, UT 84102-3515
Phone (801) 410-4281

Other practice location 1

251 Rhode Island St Ste 110
San Francisco, CA 94103-5168
Phone (415) 896-4393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Mar 23, 2023 through Mar 23, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11046583-9934UTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist PastSince May 14, 2019 Accepting new patients

Organizations & group practices 7

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": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1891216909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S 800 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023515",
            "telephone_number": "801-410-4281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S 800 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841023515",
            "telephone_number": "801-819-9084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "251 Rhode Island St Ste 110",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941035168",
            "country_code": "US",
            "telephone_number": "415-896-4393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUNDQUIST",
        "first_name": "STEPHEN",
        "middle_name": "NICHOLAS",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2022-07-21",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "11046583-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.