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SHOPKO STORES OPERATING CO. LLC NPI 1124070644


NPI Information

NPI: 1124070644
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 056

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
14445 W CENTER RD
OMAHA, NE
ZIP 68144
Phone: (402) 333-7462
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Omaha, 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 1124070644. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 056.

The provider's business location address is:

14445 W CENTER RD
OMAHA, NE
ZIP 68144-401
Phone: (402) 333-7462

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
1CP2230-30OTHEREYEMED
25695760008MEDICARE NSCNEBRASKA
317890OTHERMEDICARE
435866OTHERDAVIS
5DF0848MEDICARE PIN
6099830MEDICARE PINNEBRASKA
735503OTHERAVESIS
8009774OTHERBLOCK
90154160131MEDICARE ID-TYPE UNSPECIFIED
1041098505420MEDICAIDNEBRASKA
11092603OTHERMEDICARE
12014056OTHERVIP

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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