1750373411 NPI number — DR. RICK W WINWARD O.D.

Table of content: DR. RICK W WINWARD O.D. (NPI 1750373411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750373411 NPI number — DR. RICK W WINWARD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINWARD
Provider First Name:
RICK
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750373411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
631 N 540 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLETON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84664-3773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-491-9864
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 E UNIVERSITY PKWY # E100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84097-7400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-788-3832
Provider Business Practice Location Address Fax Number:
801-224-3600
Provider Enumeration Date:
08/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4944080-9934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 4944080-9934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)