Basic Information
| Provider Information | |||||||||
| NPI: | 1083987994 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANDARD OPTICAL COMPANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 PARKWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841192001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018862020 | ||||||||
| FaxNumber: | 8019540054 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 N 325 E | ||||||||
| Address2: | |||||||||
| City: | HARRISVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018279000 | ||||||||
| FaxNumber: | 8018279003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2012 | ||||||||
| LastUpdateDate: | 11/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | SCHUBACH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8018862020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 520 | UT | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.