Healthcare Provider Details

I. General information

NPI: 1164125639
Provider Name (Legal Business Name): CENTRAL UTAH OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N 980 W
OREM UT
84057-7709
US

IV. Provider business mailing address

1735 N STATE ST
PROVO UT
84604-1010
US

V. Phone/Fax

Practice location:
  • Phone: 801-426-9800
  • Fax: 801-426-9700
Mailing address:
  • Phone: 801-374-1818
  • Fax: 801-374-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRITTNEY WACHTER
Title or Position: CEO
Credential:
Phone: 801-379-2904