Provider Demographics
NPI:1053723262
Name:CHATWIN, ROSS JEX (OD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:JEX
Last Name:CHATWIN
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 1:2178 S 900 E STE 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2388
Mailing Address - Country:US
Mailing Address - Phone:801-484-2020
Mailing Address - Fax:
Practice Address - Street 1:1792 W 1700 S STE 202
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9651
Practice Address - Country:US
Practice Address - Phone:801-774-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9033347-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist