Provider Demographics
NPI:1063472538
Name:BRIGGS, ROBERT S (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2670 DAYBREAKER DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5804
Mailing Address - Country:US
Mailing Address - Phone:435-649-2573
Mailing Address - Fax:435-647-7725
Practice Address - Street 1:1920 PROSPECTOR AVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7209
Practice Address - Country:US
Practice Address - Phone:435-649-5200
Practice Address - Fax:435-649-2644
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1104259934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTT78153Medicare UPIN