Provider Demographics
NPI:1740272319
Name:RICE, ROBERT BRADLEY (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
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 1:1147 E DRAPER PARKWAY
Mailing Address - Street 2:
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 1:1147 E DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9096
Practice Address - Country:US
Practice Address - Phone:801-619-9555
Practice Address - Fax:801-406-0444
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344994-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005751101Medicare ID - Type Unspecified