Organization
STANDARD OPTICAL CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN ACKER CPA (CFO)
(801) 886-2020
Entity
Organization
Contact information
Practice address
1076 LAYTON HILLS MALL, SUITE 2090, LAYTON, UT 84041-2104
(801) 546-0255
(801) 546-0260
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
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174624787
BILLING OFFICE NPI
UT
05
—
1760583298
—
UT
01
—
241764
DMBA
UT
01
—
269929
ALTIUS
UT
05
—
999000797009
—
UT
01
—
A001
TRICARE
UT
Enumeration date
09/26/2006
Last updated
09/16/2009
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