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SHOPKO STORES OPERATING CO. LLC NPI 1164474698


NPI Information

NPI: 1164474698
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 038

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
2208 N WEBB RD
GRAND ISLAND, NE
ZIP 68803
Phone: (308) 382-7661
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Grand Island, 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 1164474698. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 038.

The provider's business location address is:

2208 N WEBB RD
GRAND ISLAND, NE
ZIP 68803-739
Phone: (308) 382-7661

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
1914651OTHERBLOCK
2099548OTHERMEDICARE
3099830MEDICARE PINNEBRASKA
4DF0848MEDICARE PIN
5014038OTHERVIP
61111590014MEDICARE ID-TYPE UNSPECIFIED
75695760065MEDICARE NSCNEBRASKA
835496OTHERAVESIS
910025074000MEDICAIDNEBRASKA
1017882OTHERMEDICARE
1135858OTHERDAVIS
12213121-23OTHEREYEMED

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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