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SHOPKO STORES OPERATING CO. LLC NPI 1437101698


NPI Information

NPI: 1437101698
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 082

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
5959 S STATE ST
MURRAY, UT
ZIP 84107
Phone: (801) 261-1113
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Murray, UT. 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 1437101698. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shopko Optical 082.

The provider's business location address is:

5959 S STATE ST
MURRAY, UT
ZIP 84107-222
Phone: (801) 261-1113

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 7/10/2008.


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
1152W00000XOptometristNo
2156FX1800XTechnician/TechnologistOpticianNo
3332H00000XEyewear 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
142539OTHERDAVIS
20154160176MEDICARE ID-TYPE UNSPECIFIED
3410985054-084MEDICAIDUTAH
45695760045MEDICARE NSCUTAH
5CP2230-44OTHEREYEMED
6014082OTHERVIP
717916OTHERMEIDCARE
8UT04873OTHERUTAHNORIDIAN SUBMITTER ID
9000058212MEDICARE PINUTAH
10DF0852MEDICARE 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: 11/14/2023

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