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NPI Code Detail

MEDICARE: STANDARD OPTICAL CO

MEDICARE: STANDARD OPTICAL CO
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
1152W00000XOptometristUT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2638852OTHERUTDMBA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962599290
Entity Type Code : Organization
Provider Name (Legal Business Name) : STANDARD OPTICAL CO
Provider Business Mailing Address
First Line : 1901 W PARKWAY BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84119
Country : US
Telephone Number : 801-886-2020
Fax Number : 801-954-0054
Provider Business Practice Location Address
First Line : 2190 HIGHLAND DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2807
Country : US
Telephone Number : 801-487-4138
Fax Number : 801-467-4813
Authorized Official
Title or Position : CFO
Name : KEN ACKER
Credential : CPA
Telephone Number : 801-886-2020
Provider Enumeration Date : 10/06/2006
Last Update Date : 09/15/2009

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Directions to “STANDARD OPTICAL CO ” Practice Location

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