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SHOPKO STORES OPERATING CO. LLC NPI 1114970985


NPI Information

NPI: 1114970985
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 108

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
955 N MAIN ST
SPANISH FORK, UT
ZIP 84660
Phone: (801) 798-3557
Get Directions

SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Spanish Fork, 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 1114970985. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shopko Optical 108.

The provider's business location address is:

955 N MAIN ST
SPANISH FORK, UT
ZIP 84660-150
Phone: (801) 798-3557

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 5/19/2006 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
1CP2230-52OTHEREYEMED
217931OTHERMEDICARE
342506OTHERDAVIS
4000058212MEDICARE PINUTAH
5014108OTHERVIP
60154160104MEDICARE ID-TYPE UNSPECIFIED
735536OTHERAVESIS
8UT04874OTHERUTAHNORIDIAN SUBMITTER ID
9410985054-300MEDICAIDUTAH
105695760038MEDICARE NSCUTAH
11DF0852MEDICARE 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: 4/28/2024

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