Sugarhouse Vision Clinic

Primary specialty

OptometristTaxonomy code 152W00000X

License

1932292281 Issued in UT

Legal business name

SUGARHOUSE VISION CLINIC

Practice address

2178 S 900 E Ste 4
Salt Lake City, UT 84106-2388

Phone

(801) 484-2020

Fax

(801) 466-2865

NPI assigned

Jun 5, 2007

Last updated

Jun 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Todd Kimball, O.D.NPI 1932292281

Title

President

Phone

(801) 484-2020

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Practitioners 3

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.

• Ross Jex Chatwin, OD

  • Optometrist
  • Syracuse, UT
  • NPI 1053723262
  Medicare reassignment
• Todd Evan Kimball, O.D.

  • Optometrist
  • Salt Lake City, UT
  • NPI 1932292281
  Authorized official Same address or phone
• Conner Steven Dewey, OD

  • Optometrist
  • Salt Lake City, UT
  • NPI 1306680178
  NPD

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1912100348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2178 S 900 E STE 4",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062388",
            "telephone_number": "801-484-2020",
            "fax_number": "801-466-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2178 S 900 E STE 4",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062388",
            "telephone_number": "801-484-2020",
            "fax_number": "801-466-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUGARHOUSE VISION CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-484-2020",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "UT",
            "license": "1932292281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sugar House Dental Care
• Sugar House Dental Management LLC (The Sugar House Dentist)
• Sugarhouse Center Fo Healing
• Sugarhouse Dental Inc (Sleep Well Utah)
• Sugarhouse Foot Care Inc
• Steven Gregory Sugden, M.D.
• Lisa Michelle Sugerman-Hermansen, PHD
• Steven Alan Sugerman, PA
• Irene Suh
• Faalaa Suisala

• Optometrist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.