Provider Demographics
NPI:1912183948
Name:OPTICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:OPTICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-399-9873
Mailing Address - Street 1:1196 30TH ST.
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0353
Mailing Address - Country:US
Mailing Address - Phone:801-399-9873
Mailing Address - Fax:801-399-2013
Practice Address - Street 1:1196 30TH ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0353
Practice Address - Country:US
Practice Address - Phone:801-399-9873
Practice Address - Fax:801-399-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0372640001Medicare NSC