Active NPI
Standard Optical Co
- Optometrist
- West Jordan, UT
National Provider Identifier
1861593386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- STANDARD OPTICAL CO
- Practice address
- 1656 W 9000 S
West Jordan, UT 84088-9222 - Phone
- (801) 225-5454
- Fax
- (801) 255-1109
- NPI assigned
- Sep 26, 2006
- 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
- Ken Acker, CPA
- Title
- Cfo
- Phone
- (801) 886-2020
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | UT | Primary |
Addresses
Primary practice location
1656 W 9000 S
West Jordan, UT 84088-9222
Mailing address
1901 W Parkway Blvd
Salt Lake City, UT 84119
Phone (801) 886-2020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861593386 | Medicaid | UT | |
| 829552 | Other | UT | DMBA |
| 999000797009 | Medicaid | UT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| 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… |
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 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Roy, UT
- NPI 1376713586
-
- Optometrist
- Murray, UT
- NPI 1255562740
-
- Optometrist
- Salt Lake City, UT
- NPI 1497844690
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": "1861593386",
"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": "1656 W 9000 S",
"city": "WEST JORDAN",
"state": "UT",
"postal_code": "840889222",
"telephone_number": "801-225-5454",
"fax_number": "801-255-1109"
}
],
"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": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": "UT",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861593386",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMBA",
"identifier": "829552",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "999000797009",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Jordan, 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.