Active NPI
Standard Optical Co
- Optometrist
- Provo, UT
National Provider Identifier
1891882155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- STANDARD OPTICAL CO
- Practice address
- 1200 Provo Towne Centre
1060
Provo, UT 84601 - Phone
- (801) 373-2254
- Fax
- (801) 852-5014
- NPI assigned
- Oct 6, 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
1200 Provo Towne Centre
1060
Provo, UT 84601
Mailing address
1901 W Parkway Blvd
Salt Lake City, UT 84119
Phone (801) 886-2020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891882155 | Medicaid | UT | |
| 999000797009 | Medicaid | UT |
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 DirectoryLocations
1438 E Main St
Ste 4
Lehi, UT 84043
Phone (801) 753-7909
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- West Haven, UT
- NPI 1104050483
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1252972800000",
"number": "1891882155",
"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": "1200 PROVO TOWNE CENTRE",
"address_2": "1060",
"city": "PROVO",
"state": "UT",
"postal_code": "84601",
"telephone_number": "801-373-2254",
"fax_number": "801-852-5014"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STANDARD OPTICAL CO",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-06",
"last_updated": "2009-09-15",
"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": "1891882155",
"state": "UT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "999000797009",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.