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General NPI Number Information
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NPI Number | 1760583298
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Entity Type | Organization
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Legal Business Name | STANDARD OPTICAL CO
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 1076 LAYTON HILLS MALL SUITE 2090
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City | LAYTON
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State | UT
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Zip | 84041-2104
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Country | US
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Telephone | 801-546-0255
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Fax | 801-546-0260
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Provider Business Mailing Address
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Address Line | 1901 W PARKWAY BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84119
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Country | US
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Telephone | 801-886-2020
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Fax | 801-954-0054
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Authorized Official
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Title or Position | CFO
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Name | KEN ACKER
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Credential | CPA
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Telephone | 801-886-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | UT
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