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SHOPKO STORES OPERATING CO. LLC NPI 1366495954


NPI Information

NPI: 1366495954
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 036

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
3708 HWY 63 N
ROCHESTER, MN
ZIP 55906
Phone: (507) 281-0657
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Rochester, MN. 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 1366495954. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 036.

The provider's business location address is:

3708 HWY 63 N
ROCHESTER, MN
ZIP 55906-902
Phone: (507) 281-0657

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 5/18/2006 and was last updated on 4/15/2008.


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
135472OTHERAVESIS
236056OTHERMN HEALTH PARTNERS
3DF0849MEDICARE PIN
420019120529OTHERMN MA PRIMEWEST HEALTH
51111590015MEDICARE ID-TYPE UNSPECIFIED
6C04276MEDICARE PIN
742619OTHERDAVIS
8213121-16OTHEREYEMED
964031SHOTHERMN MA FIRST PLAN OF MN
1017826OTHERMEDICARE
11411740865-4036OTHERNATIONAL VISION ADMIN.
125695760079MEDICARE NSCMINNESOTA

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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