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SALT LAKE RETINA LLC NPI 1144622234


NPI Information

NPI: 1144622234
Provider Name: SALT LAKE RETINA, LLC

Doing Business As: SALT LAKE RETINA

Classification: Ophthalmology - 207WX0107X
Entity Type: Organization

Specialization: Retina Specialist

Address:
3855 W 7800 S
SUITE 100
WEST JORDAN, UT
ZIP 84088
Phone: (801) 260-0034
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SALT LAKE RETINA, LLC is a retina specialist ophthalmology in West Jordan, UT. The provider is an ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases. SALT LAKE RETINA, LLC NPI is 1144622234. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Salt Lake Retina.

The provider's business location address is:

3855 W 7800 S
SUITE 100
WEST JORDAN, UT
ZIP 84088-560
Phone: (801) 260-0034
Fax: (801) 260-0035

The provider's authorized official is Douglas S Mehr .
The authorized official title is President and has the following contact phone number (801) 260-0034.

The enumeration date for this NPI number is 9/19/2014 and was last updated on 4/10/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207W00000XOphthalmologyNo
2207W00000XOphthalmology5934492-1205UTAHNo
3207WX0107XOphthalmologyRetina SpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11508052234MEDICAIDUTAH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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