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SHOPKO STORES OPERATING CO. LLC NPI 1265484265


NPI Information

NPI: 1265484265
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 012

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
1100 E RIVERVIEW EXPY
WISCONSIN RAPIDS, WI
ZIP 54494
Phone: (715) 423-1340
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Wisconsin Rapids, WI. 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 1265484265. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 012.

The provider's business location address is:

1100 E RIVERVIEW EXPY
WISCONSIN RAPIDS, WI
ZIP 54494-483
Phone: (715) 423-1340

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 5/17/2006 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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
142587OTHERDAVIS
2410985054-4012OTHERNVA
30154160095MEDICARE ID-TYPE UNSPECIFIED
435595OTHERAVESIS
538409000MEDICAIDWISCONSIN
65695760005MEDICARE NSCWISCONSIN
7DF0804MEDICARE PIN
8CP2230-93OTHEREYEMED
9014012OTHERVIP
1013864OTHERMEDICARE
1187832OTHERMEDICARE

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: 5/5/2024
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