Provider Demographics
NPI:1184799173
Name:MOUNT OLYMPUS OPTICAL
Entity type:Organization
Organization Name:MOUNT OLYMPUS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAO
Authorized Official - Phone:801-424-3937
Mailing Address - Street 1:1485 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1412
Mailing Address - Country:US
Mailing Address - Phone:801-277-2062
Mailing Address - Fax:801-277-3233
Practice Address - Street 1:1485 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1412
Practice Address - Country:US
Practice Address - Phone:801-277-2062
Practice Address - Fax:801-277-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49855156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty