NPIMap

Organization Active NPI

Standard Optical Co

  • Optometrist
  • South Jordan, UT
National Provider Identifier
1114377165
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
STANDARD OPTICAL CO
Practice address
11514 S 4000 W
BLDG H Suite 103
South Jordan, UT 84009-6014
Phone
(801) 727-8711
Fax
(801) 727-8714
NPI assigned
Jun 20, 2016
Last updated
Nov 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Authorized official

Name
Stephen Schubach
Title
President
Phone
(801) 886-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

11514 S 4000 W
BLDG H Suite 103
South Jordan, UT 84009-6014

Mailing address

1901 W Parkway Blvd
Salt Lake City, UT 84119-2001
Phone (801) 886-2020

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

11514 S 4000 W
Ste 103
South Jordan, UT 84009
Phone (801) 214-0327

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478736000000",
    "number": "1114377165",
    "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": "841192001",
            "telephone_number": "801-886-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11514 S 4000 W",
            "address_2": "BLDG H SUITE 103",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096014",
            "telephone_number": "801-727-8711",
            "fax_number": "801-727-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANDARD OPTICAL CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-11-10",
        "status": "A",
        "authorized_official_last_name": "SCHUBACH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-886-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.