Provider Demographics
NPI:1326373408
Name:CAPSTICK, BRITTANY N (OD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:N
Last Name:CAPSTICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7456 S PARKRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4834
Mailing Address - Country:US
Mailing Address - Phone:612-308-0679
Mailing Address - Fax:
Practice Address - Street 1:489 W SOUTH JORDAN PARKWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:385-222-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14269152W00000X, 152WC0802X
UT8273555-8908152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
U000076546OtherMEDICARE PTAN