Healthcare Provider Details

I. General information

NPI: 1659958841
Provider Name (Legal Business Name): STANDARD OPTICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N 2000 W STE F1
WEST POINT UT
84015-8777
US

IV. Provider business mailing address

1901 W PARKWAY BLVD
WEST VALLEY CITY UT
84119-2001
US

V. Phone/Fax

Practice location:
  • Phone: 801-825-9732
  • Fax:
Mailing address:
  • Phone: 801-886-2020
  • Fax: 801-954-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ALYSA WOODS
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-886-2020