Standard Optical Co
Organization Active NPI Optometrist · Murray, UT
NPI 1508967977 · NPPES record last updated Sep 16, 2009
Key facts
- NPI
- 1508967977
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- STANDARD OPTICAL CO
- Practice address
- 5289 S State St
Murray, UT 84107-4828 - Phone
- (801) 506-1111
- Fax
- (801) 506-2021
- NPI assigned
- Sep 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Ken Acker, CPA
- Title
- Cfo
- Phone
- (801) 886-2020
Other NPIs on the same Medicare enrollment 19
Practitioners 51
-
Russell Purdy, OD
-
Tyler J. Barney, O.D.
-
Jonathan Boster, O.D.
-
Nathan Broschinsky, O.D.
-
Solomon Campbell, O.D.
-
Michael Wayne Cole, O.D.
-
Michael D Conklin, O.D.
-
Frank Middleton Edmunds, O.D.
-
John Ellison, O.D.
-
Rebecca Lynn Freeman, O.D.
-
Brent L Hadlock, O.D.
-
Duane Knowles, OD
-
Michael Marty, OD
-
David A Meyer, OD
-
Curtis Millet, OD
-
Edward R Nicholls, O.D.
-
Jenna O'Brien, O.D.
-
Clifford Parker, OD
-
David Parry, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Locations
5289 S State St
Murray, UT 84107
Phone (801) 506-1111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | UT | Yes |
Addresses
Primary practice location
5289 S State St
Murray, UT 84107-4828
Mailing address
1901 W Parkway Blvd
Salt Lake City, UT 84119
Phone (801) 886-2020
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 920553 | Other | UT | DMBA |
| 1508967977 | Medicaid | UT | |
| 999000797009 | Medicaid | UT |
Other providers in Murray, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.