MEDICARE: CENTRAL UTAH 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1386347623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL UTAH OPTICAL

Provider Business Mailing Address
First Line	:	1735 N STATE ST
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-1010
Country	:	US
Telephone Number	:	801-374-1818
Fax Number	:	801-374-0163

Provider Business Practice Location Address
First Line	:	118 E THRIVE DR STE 210
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-5554
Country	:	US
Telephone Number	:	801-379-2929
Fax Number	:	801-374-0163

Authorized Official
Title or Position	:	CEO
Name	:	BRITTNEY WACHTER
Credential	:
Telephone Number	:	801-379-2904

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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Directions to “CENTRAL UTAH OPTICAL ” Practice Location

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