Provider Demographics
NPI:1437580768
Name:SALT CITY OPTICS LLC
Entity Type:Organization
Organization Name:SALT CITY OPTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-550-2003
Mailing Address - Street 1:2725 E EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2804
Mailing Address - Country:US
Mailing Address - Phone:801-550-2003
Mailing Address - Fax:
Practice Address - Street 1:150 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2539
Practice Address - Country:US
Practice Address - Phone:888-458-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty