Provider Type Icon

SHOPKO STORES OPERATING CO. LLC NPI 1073565503


NPI Information

NPI: 1073565503
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 048

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
2005 KRENZIEN DR
NORFOLK, NE
ZIP 68701
Phone: (402) 379-1434
Get Directions

SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Norfolk, NE. The provider is an organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. SHOPKO STORES OPERATING CO. LLC NPI is 1073565503. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 048.

The provider's business location address is:

2005 KRENZIEN DR
NORFOLK, NE
ZIP 68701-601
Phone: (402) 379-1434

The provider's authorized official is Michael J Bettiga .
The authorized official title is Sr. Vice President Health Services and has the following contact phone number (920) 429-4297.

The enumeration date for this NPI number is 5/16/2006 and was last updated on 2/11/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332H00000XEyewear SupplierYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1007126OTHERBLOCK
2CP2230-28OTHEREYEMED
341098505421MEDICAIDNEBRASKA
45695760060MEDICARE NSCNEBRASKA
5099830MEDICARE PINNEBRASKA
617888OTHERMEDICARE
7094813OTHERMEDICARE
80154160183MEDICARE ID-TYPE UNSPECIFIED
9014048OTHERVIP
1035864OTHERDAVIS
11DF0848MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.