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OCULOPLASTIC SURGERY INC. NPI 1578780805


NPI Information

NPI: 1578780805
Provider Name: OCULOPLASTIC SURGERY, INC.

Doing Business As: STILL CANYON EYELID & FACIAL PLASTIC SURGERY

Classification: Ophthalmology - 207WX0200X
Entity Type: Organization

Specialization: Ophthalmic Plastic and Reconstructive Surgery

Address:
5200 S HIGHLAND DR STE 201
HOLLADAY, UT
ZIP 84117
Phone: (801) 363-3356
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OCULOPLASTIC SURGERY, INC. is an ophthalmic plastic and reconstructive surgery ophthalmology in Holladay, UT. The provider is a physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck. OCULOPLASTIC SURGERY, INC. NPI is 1578780805. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Still Canyon Eyelid & Facial Plastic Surgery.

The provider's business location address is:

5200 S HIGHLAND DR STE 201
HOLLADAY, UT
ZIP 84117-003
Phone: (801) 363-3356
Fax: (801) 533-9613

The provider's authorized official is Thomas J J Oberg .
The authorized official title is Provider/owner and has the following contact phone number (801) 363-3356.

The enumeration date for this NPI number is 4/19/2007 and was last updated on 9/29/2023.


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
1207WX0200XOphthalmologyOphthalmic Plastic and Reconstructive SurgeryYes

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
1479544679030MEDICAIDUTAH
2464491680001MEDICAIDUTAH
3485924851015MEDICAIDUTAH

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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