NPIMap

Organization Active NPI

Standard Optical Co

  • Optometrist
  • Salt Lake City, UT
National Provider Identifier
1962599290
Registry record updated Sep 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
STANDARD OPTICAL CO
Practice address
2190 Highland Dr
Salt Lake City, UT 84106-2807
Phone
(801) 487-4138
Fax
(801) 467-4813
NPI assigned
Oct 6, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Ken Acker, CPA
Title
Cfo
Phone
(801) 886-2020

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 55

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Medicare enrollment records 1

Medicare enrollment files
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…

National Provider Directory

National Provider Directory

Locations

2124 S Highland Dr
Salt Lake City, UT 84106
Phone (801) 487-4138

2190 Highland Dr
Salt Lake City, UT 84106
Phone (801) 487-4138

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X UT Primary

Addresses

NPPES NPI Registry

Primary practice location

2190 Highland Dr
Salt Lake City, UT 84106-2807

Mailing address

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

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
PRA03404OtherUTMOLINA MEDICAID
638852OtherUTDMBA
999000797009MedicaidUT
1962599290MedicaidUT

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 15, 2009.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1962599290",
    "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": "2190 HIGHLAND DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841062807",
            "telephone_number": "801-487-4138",
            "fax_number": "801-467-4813"
        }
    ],
    "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA MEDICAID",
            "identifier": "PRA03404",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMBA",
            "identifier": "638852",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999000797009",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962599290",
            "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 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.

Verify at the official NPI Registry.