Organization
DEPARTMENT OF OPHTHALMOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL J OLSON MD (DEPARTMENT CHAIR)
(801) 587-6470
Entity
Organization
Contact information
Practice address
5126 W DAYBREAK PKWY, SOUTH JORDAN, UT 84095-5994
(801) 213-4500
Mailing address
PO BOX 413075, SALT LAKE CITY, UT 84141-3075
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
09/26/2012
Last updated
09/26/2012
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