NPIMap

Organization Active NPI

Standard Optical Co

  • Optometrist
  • Holladay, UT
National Provider Identifier
1043311582
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
STANDARD OPTICAL CO
Practice address
4878 Highland Dr
Creekside Plaza
Holladay, UT 84117-6007
Phone
(801) 272-8861
Fax
(801) 272-8867
NPI assigned
Sep 26, 2006
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alysa Woods
Title
Office Manager
Phone
(801) 886-2020

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X UT Primary
Ophthalmology Physician 207W00000X UT

Addresses

Primary practice location

4878 Highland Dr
Creekside Plaza
Holladay, UT 84117-6007

Mailing address

1901 W Parkway Blvd
Salt Lake City, UT 84119
Phone (801) 886-2020

Other identifiers 4

IdentifierTypeStateIssuer
920555OtherUTDMBA
269929OtherUTALTIUS
1043311582MedicaidUT
999000797009MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000787 UT Part B Supplier - Clinic/Group Practice 8224921390 Receives reassigned benefits from 25 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Provo, UT; Roy, UT; Salt Lake City, UT; Sandy, UT; South Jordan, UT; St George, UT; Taylorsville, UT; Tooele, UT…

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory

Locations

4878 S Highland Dr
Holladay, UT 84117
Phone (801) 272-8861

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1043311582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 W PARKWAY BLVD",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84119",
            "telephone_number": "801-886-2020",
            "fax_number": "801-954-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4878 HIGHLAND DR",
            "address_2": "CREEKSIDE PLAZA",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841176007",
            "telephone_number": "801-272-8861",
            "fax_number": "801-272-8867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANDARD OPTICAL CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "WOODS",
        "authorized_official_first_name": "ALYSA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-886-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "920555",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "269929",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043311582",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999000797009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holladay, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.