MEDICARE: SALT OPTICAL LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1760913552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALT OPTICAL LLC

Provider Business Mailing Address
First Line	:	1499 REGAL ROW STE 409
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3634
Country	:	US
Telephone Number	:	972-629-9853
Fax Number	:	972-637-7376

Provider Business Practice Location Address
First Line	:	1499 REGAL ROW STE 409
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3634
Country	:	US
Telephone Number	:	972-629-9853
Fax Number	:	972-637-7376

Authorized Official
Title or Position	:	MASTER OPTICIAN
Name	:	KIRSTEN ELISE DUNN
Credential	:	A.B.O.
Telephone Number	:	817-807-2873

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	03/23/2017

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Directions to “SALT OPTICAL LLC ” Practice Location

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