Provider Demographics
NPI:1467444273
Name:RICE, DALLIN W (OD)
Entity Type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:W
Last Name:RICE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1223 E 12300 S
Mailing Address - Street 2:STE A
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9024
Mailing Address - Country:US
Mailing Address - Phone:801-619-9555
Mailing Address - Fax:801-406-0444
Practice Address - Street 1:1223 E 12300 S
Practice Address - Street 2:STE A
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9024
Practice Address - Country:US
Practice Address - Phone:801-619-9555
Practice Address - Fax:801-406-0444
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49512859934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$001Medicaid
UT$$$$$$$$$001Medicaid
UTU88325Medicare UPIN