Provider Demographics
NPI:1114377165
Name:STANDARD OPTICAL CO
Entity Type:Organization
Organization Name:STANDARD OPTICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-886-2020
Mailing Address - Street 1:1901 W PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2001
Mailing Address - Country:US
Mailing Address - Phone:801-886-2020
Mailing Address - Fax:
Practice Address - Street 1:11514 S 4000 W
Practice Address - Street 2:BLDG H SUITE 103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-6014
Practice Address - Country:US
Practice Address - Phone:801-727-8711
Practice Address - Fax:801-727-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty