Provider Demographics
NPI:1861141822
Name:ROCKY MOUNTAIN UNIVERSITY HEALTH CENTER
Entity type:Organization
Organization Name:ROCKY MOUNTAIN UNIVERSITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN
Authorized Official - Prefix:
Authorized Official - First Name:COURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-899-6527
Mailing Address - Street 1:122 E 1700 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5644
Mailing Address - Country:US
Mailing Address - Phone:385-248-5550
Mailing Address - Fax:
Practice Address - Street 1:970 S EMERY ST
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84104-2050
Practice Address - Country:US
Practice Address - Phone:385-248-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty