Organization
STANDARD OPTICAL CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYSA WOODS (OFFICE MANAGER)
(801) 886-2020
Entity
Organization
Contact information
Practice address
4878 HIGHLAND DR, CREEKSIDE PLAZA, HOLLADAY, UT 84117-6007
(801) 272-8861
(801) 272-8867
Mailing address
1901 W PARKWAY BLVD, SALT LAKE CITY, UT 84119
(801) 886-2020
(801) 954-0054
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
UT
207W00000X
Ophthalmology Physician
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043311582
—
UT
01
—
269929
ALTIUS
UT
01
—
920555
DMBA
UT
05
—
999000797009
—
UT
Enumeration date
09/26/2006
Last updated
03/23/2021
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