MEDICARE: MOUNT OLYMPUS OPTICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	49855	UT

General Provider Information

NPI Number	:	1184799173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT OLYMPUS OPTICAL

Provider Business Mailing Address
First Line	:	1485 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1412
Country	:	US
Telephone Number	:	801-277-2062
Fax Number	:	801-277-3233

Provider Business Practice Location Address
First Line	:	1485 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1412
Country	:	US
Telephone Number	:	801-277-2062
Fax Number	:	801-277-3233

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HOWARD A KATZMAN
Credential	:	M.D., F.A.A.O.
Telephone Number	:	801-424-3937

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/22/2020

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