Provider Demographics
NPI:1700062049
Name:COTTONWOOD OPHTHALMOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:COTTONWOOD OPHTHALMOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:ALDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-262-3344
Mailing Address - Street 1:164 E 5900 S
Mailing Address - Street 2:#A101
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:164 E 5900 S
Practice Address - Street 2:#A101
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7256
Practice Address - Country:US
Practice Address - Phone:801-262-3344
Practice Address - Fax:801-262-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT290691-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty