Provider Demographics
NPI:1447313416
Name:ROPER, RONALD SCOTT (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:ROPER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544W 6200 S 104
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3206
Mailing Address - Country:US
Mailing Address - Phone:801-966-2020
Mailing Address - Fax:801-966-5038
Practice Address - Street 1:3544 W 6200 S 104
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3206
Practice Address - Country:US
Practice Address - Phone:801-966-2020
Practice Address - Fax:801-966-5038
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5189880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU88256Medicare UPIN