NPIMap

Organization Active NPI

Standard Optical Co

  • Optometrist
  • Orem, UT
National Provider Identifier
1093816548
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
STANDARD OPTICAL CO
Practice address
1455 S State St
Orem, UT 84097-7748
Phone
(801) 226-3044
Fax
(801) 802-7326
NPI assigned
Sep 26, 2006
Last updated
Sep 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

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

Authorized official

Name
Ken Acker, CPA
Title
Cfo
Phone
(801) 886-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X UT Primary

Addresses

Primary practice location

1455 S State St
Orem, UT 84097-7748

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
1174624787MedicaidUT
1174624787OtherUTBILLING OFFICE NPI
1093816548OtherUTSTORE NPI
999000797009MedicaidUT
116257OtherUTDMBA

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
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

1438 E Main St
Ste 4
Lehi, UT 84043
Phone (801) 753-7909

Practitioners & affiliated clinicians

Practitioners 25

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 25

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": "1253059200000",
    "number": "1093816548",
    "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": "1455 S STATE ST",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840977748",
            "telephone_number": "801-226-3044",
            "fax_number": "801-802-7326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANDARD OPTICAL CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2009-09-16",
        "status": "A",
        "authorized_official_last_name": "ACKER",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "801-886-2020",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174624787",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING OFFICE NPI",
            "identifier": "1174624787",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STORE NPI",
            "identifier": "1093816548",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999000797009",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "116257",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; 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.