Provider Demographics
NPI:1467559492
Name:ROCKY MOUNTAIN OPTICAL
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:KNOWLTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-264-4406
Mailing Address - Street 1:4400 S 700 E
Mailing Address - Street 2:STE 160
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3053
Mailing Address - Country:US
Mailing Address - Phone:801-264-4430
Mailing Address - Fax:801-264-4431
Practice Address - Street 1:4400 S 700 E
Practice Address - Street 2:STE 160
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3053
Practice Address - Country:US
Practice Address - Phone:801-264-4430
Practice Address - Fax:801-264-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========000Medicaid
UT1108610001Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #