Provider Demographics
NPI:1134822604
Name:CENTRAL UTAH OPTICAL
Entity type:Organization
Organization Name:CENTRAL UTAH OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-379-2904
Mailing Address - Street 1:1735 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1010
Mailing Address - Country:US
Mailing Address - Phone:801-374-1818
Mailing Address - Fax:801-374-0163
Practice Address - Street 1:1172 E 100 N
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1667
Practice Address - Country:US
Practice Address - Phone:801-465-2575
Practice Address - Fax:801-465-0629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL UTAH OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier