Provider Demographics
NPI:1760913552
Name:SALT OPTICAL LLC
Entity Type:Organization
Organization Name:SALT OPTICAL LLC
Other - Org Name:SALT OPTICAL LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MASTER OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:817-807-2873
Mailing Address - Street 1:1499 REGAL ROW STE 409
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3634
Mailing Address - Country:US
Mailing Address - Phone:972-629-9853
Mailing Address - Fax:972-637-7376
Practice Address - Street 1:1499 REGAL ROW STE 409
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3634
Practice Address - Country:US
Practice Address - Phone:972-629-9853
Practice Address - Fax:972-637-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies