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

Dr. Kevin Mark Ellsworth, OD

Individual provider Optometrist · NPI 1669457024

Dr. Kevin Mark Ellsworth, OD is an Optometry in Logan, Utah. Graduated from Southern California College of Optometry in 1985, 41 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
41
Trained at
Southern California College of Optometry
Licensed in
UT
In the registry since
2005
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

395 E 1400 N Ste B
Logan, UT 84341-7573
Phone: (435) 752-5585
Fax: (435) 787-2871
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 112376-9934 (UT)

Record details

NPI number1669457024
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorYes
NPI enumeratedDecember 8, 2005
Last updated in NPPESAugust 20, 2008

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolSOUTHERN CALIFORNIA COLLEGE OF OPTOMETRY
Graduated 1985 (41 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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