Salt Lake City Eye Care, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

6271198-9934 Issued in UT

Legal business name

SALT LAKE CITY EYE CARE, LLC

Practice address

1818 S 300 W
Salt Lake City, UT 84115-1805

Phone

(801) 485-9757

Fax

(801) 477-8359

NPI assigned

Sep 25, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Mark Matthew McKell, ODNPI 1396853974

Title

Owner

Phone

(801) 485-9757

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Matthew McKell, O.D.

  • Optometrist
  • Nampa, ID
  • NPI 1396853974

  UT

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952810731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 SOUTH 300 WEST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84115",
            "telephone_number": "801-485-9757",
            "fax_number": "801-477-8359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 S 300 W",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841151805",
            "telephone_number": "801-485-9757",
            "fax_number": "801-477-8359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALT LAKE CITY EYE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MCKELL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-485-9757",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "UT",
            "license": "6271198-9934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396853974",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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 Jul 21, 2022; 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.