SHOPKO STORES OPERATING CO. LLC NPI 1174575500

NPI Information

NPI: 1174575500
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 4017

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
4161 2ND ST S
SAINT CLOUD, MN
ZIP 56301
Phone: (320) 253-5994
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Saint Cloud, MN. 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 1174575500. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 4017.

The provider's business location address is:

4161 2ND ST S
SAINT CLOUD, MN
ZIP 56301-761
Phone: (320) 253-5994

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 4/15/2008.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332H00000X	Eyewear Supplier				Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	23667	OTHER		MN HEALTH PARTNERS
2	35585	OTHER		AVESIS
3	CP2230-22	OTHER		EYEMED
4	2123169	OTHER		MN MA MEDICA CHOICE CARE
5	0154160098	MEDICARE ID-TYPE UNSPECIFIED
6	DF0849	MEDICARE PIN
7	77166SH	OTHER		MN MA FIRST PLAN OF MN
8	C04276	MEDICARE PIN
9	014017	OTHER		VIP
10	77168MA	OTHER		MN BLUE PLUS CARE
11	410985054-4017	OTHER		NATIONAL VISION ADMIN.
12	5695760020	MEDICARE NSC	MINNESOTA
13	35479	OTHER		AVESIS
14	42601	OTHER		DAVIS
15	03092036202	OTHER		MN MA PRIMEWEST HEALTH
16	17821	OTHER		MEDICARE

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: 4/28/2024

NPI Synchronization or Removal

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