Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Roosevelt Vision Clinic, PC

Organization Optometrist · NPI 1710973052

Roosevelt Vision Clinic, PC is an Optometrist in Roosevelt, Utah. Licensed in Utah. Registered with an NPI since 2005.

Licensed in
UT
In the registry since
2005
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

165 W 200 N 71-7
Roosevelt, UT 84066-2834
Phone: (435) 722-2981
Fax: (435) 722-3732
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 111999-9934 (UT)

Record details

NPI number1710973052
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Scott Kowallis — Owner/Doctor · (435) 722-2981
NPI enumeratedSeptember 22, 2005
Last updated in NPPESAugust 27, 2008
Mailing address165 W 200 N, 71-7, Roosevelt, UT 84066-2834

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