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SHOPKO STORES OPERATING CO. LLC NPI 1982656419


NPI Information

NPI: 1982656419
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 086

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
2266 N UNIVERSITY PKWY
PROVO, UT
ZIP 84604
Phone: (801) 373-1300
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Provo, 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 1982656419. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shopko Optical 086.

The provider's business location address is:

2266 N UNIVERSITY PKWY
PROVO, UT
ZIP 84604-510
Phone: (801) 373-1300

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
1UT04881OTHERUTAHNORIDIAN SUBMITTER ID
2410985054-134MEDICAIDUTAH
317921OTHERMEDICARE
435529OTHERAVESIS
5DF0852MEDICARE PIN
65695760027MEDICARE NSCUTAH
7CP2230-47OTHEREYEMED
842548OTHERDAVIS
90154160020MEDICARE ID-TYPE UNSPECIFIED
10000058212MEDICARE PINUTAH
11014086OTHERVIP

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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