# DEPT OF OPHTHALMOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194910281
- **Authorized official:** RANDALL OLSON M.D (DEPARTMENT CHAIR)
- **Authorized official phone:** (801) 581-3195

## Contact information

- **Practice address:** 65 MARIO CAPECCHI DR, SALT LAKE CITY, UT 84132-0001
- **Practice address phone:** (801) 581-3195
- **Mailing address:** PO BOX 413075, SALT LAKE CITY, UT 84141-3075
- **Mailing address phone:** (801) 581-3195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2007
- **Last updated:** 11/07/2012