Active NPI
Standard Optical Co
- Optometrist
- Salt Lake City, UT
National Provider Identifier
1174624787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- STANDARD OPTICAL CO
- Practice address
- 1901 W Parkway Blvd
Salt Lake City, UT 84119 - Phone
- (801) 886-2020
- Fax
- (801) 954-0054
- NPI assigned
- Sep 26, 2006
- Last updated
- Jan 30, 2018
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | NU | Primary | |
| Ophthalmology Physician | 207W00000X | NU |
Addresses
Primary practice location
1901 W Parkway Blvd
Salt Lake City, UT 84119
Mailing address
1901 W Parkway Blvd
Salt Lake City, UT 84119
Phone (801) 886-2020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999000797009 | Medicaid | UT | |
| PRA03404 | Other | UT | MOLINA MEDICAID |
| 1700082104 | Other | UT | MEDICAID (WYATT) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
Other NPIs on the same Medicare enrollment 19
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
-
- Optometrist
- Idaho Falls, ID
- NPI 1154432938
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": "1517270400000",
"number": "1174624787",
"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": "1901 W PARKWAY BLVD",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84119",
"telephone_number": "801-886-2020",
"fax_number": "801-954-0054"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STANDARD OPTICAL CO",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-26",
"last_updated": "2018-01-30",
"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": "NU",
"license": null,
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "999000797009",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA MEDICAID",
"identifier": "PRA03404",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID (WYATT)",
"identifier": "1700082104",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.