# DEPARTMENT OF OPHTHALMOLOGY

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

## Provider details

- **NPI number:** 1851327415
- **Authorized official:** RANDALL J OLSON MD (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 | — | — | — |
| 152WP0200X | Pediatric Optometrist | — | NULL | — |
| 152WP0200X | Pediatric Optometrist | — | — | — |
| 156FC0800X | Contact Lens Technician/Technologist | — | NULL | — |
| 156FC0800X | Contact Lens Technician/Technologist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/24/2006
- **Last updated:** 04/10/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 100503634 | NEVADA MEDICAID | NV |
| 01 | — | 122455700 | WYOMING MEDICAID | WY |
| 01 | — | 805078300 | IDAHO MEDICAID | ID |