| David Thomas Brockbank, MD | |
|
6065 Fashion Blvd, Ste 125, Murray, UT 84107-7381 | |
| (801) 261-0726 | |
| (801) 262-2838 |
| Full Name | David Thomas Brockbank |
|---|---|
| Gender | Male |
| Speciality | Ophthalmology |
| Location | 6065 Fashion Blvd, Murray, Utah |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093822561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207W00000X | Ophthalmology | T2003013455 (Missouri) | Secondary |
| 207W00000X | Ophthalmology | 6540468-1205 (Utah) | Primary |
| Entity Name | Central Utah Clinic Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093764805 PECOS PAC ID: 7517868508 Enrollment ID: O20040113000805 |
| Entity Name | Olympus Eye Associates Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912202425 PECOS PAC ID: 9739360181 Enrollment ID: O20110218000309 |
| Mailing Address | Practice Location Address |
|---|---|
| David Thomas Brockbank, MD 1055 N 500 W, Attn: Credentialing, Provo, UT 84604-3305 Ph: (801) 354-8225 | David Thomas Brockbank, MD 6065 Fashion Blvd, Ste 125, Murray, UT 84107-7381 Ph: (801) 261-0726 |
Dr. Jared Wayne Parker, MD Ophthalmology Medicare: Accepting Medicare Assignments Practice Location: 5770 S 250 E, Ste 410, Murray, UT 84107 Phone: 801-314-4420 Fax: 801-314-4421 | |
Darcy Hunt Wolsey, MD Ophthalmology Medicare: Accepting Medicare Assignments Practice Location: 5089 S 900 E Ste 200, Murray, UT 84117 Phone: 385-521-2020 Fax: 385-521-2040 | |
Dr. David J Wilde, MD Ophthalmology Medicare: Accepting Medicare Assignments Practice Location: 5872 S 900 E Ste 100, Murray, UT 84121 Phone: 801-261-0726 Fax: 801-262-2838 | |
Albert L Ungricht, MD Ophthalmology Medicare: Not Enrolled in Medicare Practice Location: 5770 S 250 E, Suite 410, Murray, UT 84107 Phone: 801-314-4420 Fax: 801-314-4421 | |
Dr. John Bryant Alder, M.D. Ophthalmology Medicare: Accepting Medicare Assignments Practice Location: 6412 S 900 E, 101, Murray, UT 84121 Phone: 801-262-3344 Fax: 801-262-4967 | |
Sally B Thompson, Ophthalmology Medicare: Not Enrolled in Medicare Practice Location: 5241 S State St, Ste 1, Murray, UT 84107 Phone: 801-281-3937 |