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SHOPKO STORES OPERATING CO. LLC NPI 1679525109


NPI Information

NPI: 1679525109
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 084

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
1553 W 9000 S
WEST JORDAN, UT
ZIP 84088
Phone: (801) 561-7300
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in West Jordan, UT. 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 1679525109. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shopko Optical 084.

The provider's business location address is:

1553 W 9000 S
WEST JORDAN, UT
ZIP 84088-219
Phone: (801) 561-7300

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 7/10/2008.


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
1152W00000XOptometristNo
2156FX1800XTechnician/TechnologistOpticianNo
3332H00000XEyewear 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
1CP2230-54OTHEREYEMED
2014084OTHERVIP
317918OTHERMEDICARE
4000058212MEDICARE PINUTAH
50154160002MEDICARE ID-TYPE UNSPECIFIED
6UT04885OTHERUTAHNORIDIAN SUBMITTER ID
75695760047MEDICARE NSCUTAH
8DF0852MEDICARE PIN
935539OTHERAVESIS
10410985054-103MEDICAIDUTAH
1142543OTHERDAVIS

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

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