Basic Information
| Provider Information | |||||||||
| NPI: | 1154438182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEATER | ||||||||
| FirstName: | RHETT | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10857 WEISS DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840957748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012178973 | ||||||||
| FaxNumber: | 2709560180 | ||||||||
| Practice Location | |||||||||
| Address1: | 1656 W 9000 S | ||||||||
| Address2: | |||||||||
| City: | WEST JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840889222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012555454 | ||||||||
| FaxNumber: | 8012551109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 10/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5682080-9934 | UT | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 1157738182 | 01 | UT | MARCH VISION | OTHER | 1154438182 | 05 | UT | MEDICAID |