1568815082 NPI number — DR. ANASTASIA NEUFELD MD, FRCSC

Table of content: DR. ANASTASIA NEUFELD MD, FRCSC (NPI 1568815082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568815082 NPI number — DR. ANASTASIA NEUFELD MD, FRCSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEUFELD
Provider First Name:
ANASTASIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FRCSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RADETSKI
Provider Other First Name:
ANASTASIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568815082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 MARIO CAPECCHI DRIVE
Provider Second Line Business Mailing Address:
UNIVERSITY OF UTAH, MORAN EYE CENTER
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-585-6788
Provider Business Mailing Address Fax Number:
801-581-5806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 MARIO CAPECCHI DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-6788
Provider Business Practice Location Address Fax Number:
801-581-5806
Provider Enumeration Date:
07/20/2016

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: 207W00000X , with the licence number:  9720888-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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