Provider Demographics
NPI:1588771414
Name:ROWLEY, BRIAN FARNSWORTH (OD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:FARNSWORTH
Last Name:ROWLEY
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 1:539 S 100 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2865
Mailing Address - Country:US
Mailing Address - Phone:801-465-0355
Mailing Address - Fax:801-465-9238
Practice Address - Street 1:675 S 100 W STE 3
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2883
Practice Address - Country:US
Practice Address - Phone:801-465-0355
Practice Address - Fax:801-465-9238
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5147143-9934152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU67146Medicaid
UTU67146Medicaid