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
2190 HIGHLAND DR, SALT LAKE CITY, UT 84106-2807
(801) 487-4138
(801) 467-4813
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
05
—
1962599290
—
UT
01
—
638852
DMBA
UT
05
—
999000797009
—
UT
01
—
PRA03404
MOLINA MEDICAID
UT
Enumeration date
10/06/2006
Last updated
09/15/2009
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