SHOPKO STORES OPERATING CO. LLC NPI 1326090424

NPI Information

  • NPI: 1326090424
  • Provider Name: SHOPKO STORES OPERATING CO. LLC
  • Classification: Eyewear Supplier - 332H00000X
  • Entity Type: Organization
  • Doing Business As: SHOPKO OPTICAL 153
  • Address: 3001 S DIRKSEN PKWY
    SPRINGFIELD, IL
    ZIP 62703
  • Phone: (217) 585-8845

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NPI Details

SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Springfield, IL. 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 1326090424. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 153.

The provider's business location address is:

3001 S DIRKSEN PKWY
SPRINGFIELD, IL
ZIP 62703-502
Phone: (217) 585-8845

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 6/4/2008.

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
117689OTHERMEDICARE
2CP2521-7OTHEREYEMED
31249550004MEDICARE ID-TYPE UNSPECIFIED
442564OTHERDAVIS
5DF0851MEDICARE PIN
6014153OTHERVIP
75695760128MEDICARE NSC
85232016OTHERILLINOISBCBS IL
9213638MEDICARE 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: 11/21/2025

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