SHOPKO STORES OPERATING CO LLC NPI 1366608440

NPI Information

  • NPI: 1366608440
  • Provider Name: SHOPKO STORES OPERATING CO LLC
  • Classification: Eyewear Supplier - 332H00000X
  • Entity Type: Organization
  • Doing Business As: SHOPKO OPTICAL 180
  • Address: 3271 MARKETPLACE DR
    COUNCIL BLUFFS, IA
    ZIP 51501
  • Phone: (712) 366-0706

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NPI Details

SHOPKO STORES OPERATING CO LLC is an eyewear supplier in Council Bluffs, IA. 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 1366608440. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 180.

The provider's business location address is:

3271 MARKETPLACE DR
COUNCIL BLUFFS, IA
ZIP 51501-908
Phone: (712) 366-0706
Fax: (712) 366-9020

The provider's authorized official is Michael 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 7/29/2008 and was last updated on 8/24/2009.

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
1135093OTHERVIP
2I17682003MEDICARE PINIOWA
31366608440OTHERWELLMARK BCBS IA
462213OTHERSPECTERA
551451OTHERAVESIS
65695760145MEDICARE NSC
7IB1322MEDICARE PIN
8A00793OTHEREYEMED

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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