# DEPARTMENT OF OPHTHALMOLOGY

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

## Provider details

- **NPI number:** 1952652273
- **Authorized official:** RANDALL J OLSON MD (DEPARTMENT CHAIR)
- **Authorized official phone:** (801) 587-6470

## Contact information

- **Practice address:** 5126 W DAYBREAK PKWY, SOUTH JORDAN, UT 84095-5994
- **Practice address phone:** (801) 213-4500
- **Mailing address:** PO BOX 413075, SALT LAKE CITY, UT 84141-3075
- **Mailing address phone:** (801) 213-3900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 152WC0802X | Corneal and Contact Management Optometrist | — | NULL | — |
| 152WC0802X | Corneal and Contact Management Optometrist | — | — | — |
| 152WL0500X | Low Vision Rehabilitation Optometrist | — | NULL | — |
| 152WL0500X | Low Vision Rehabilitation Optometrist | — | — | — |
| 152WP0200X | Pediatric Optometrist | — | NULL | — |
| 152WP0200X | Pediatric Optometrist | — | — | — |
| 152WS0006X | Sports Vision Optometrist | — | NULL | — |
| 152WS0006X | Sports Vision Optometrist | — | — | — |
| 152WV0400X | Vision Therapy Optometrist | — | NULL | — |
| 152WV0400X | Vision Therapy Optometrist | — | — | — |
| 152WX0102X | Occupational Vision Optometrist | — | NULL | — |
| 152WX0102X | Occupational Vision Optometrist | — | — | — |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2012
- **Last updated:** 09/26/2012