SHOPKO STORES OPERATING CO. LLC NPI 1760435333

NPI Information

  • NPI: 1760435333
  • Provider Name: SHOPKO STORES OPERATING CO. LLC
  • Classification: Eyewear Supplier - 332H00000X
  • Entity Type: Organization
  • Doing Business As: SHOPKO OPTICAL 150
  • Address: 3030 WABASH AVE
    SPRINGFIELD, IL
    ZIP 62704
  • Phone: (217) 698-9721

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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 1760435333. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 150.

The provider's business location address is:

3030 WABASH AVE
SPRINGFIELD, IL
ZIP 62704-413
Phone: (217) 698-9721

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 1/30/2008.

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
15695760135MEDICARE NSC
2DF0851MEDICARE PIN
31249550005MEDICARE ID-TYPE UNSPECIFIED
4213638MEDICARE PIN
5014150OTHERVIP
642563OTHERDAVIS
717688OTHERMEDICARE
8CP2521-6OTHEREYEMED

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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