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SHOPKO STORES OPERATING CO. LLC NPI 1902859515


NPI Information

NPI: 1902859515
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 062

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
301 NORTHWEST BYP
GREAT FALLS, MT
ZIP 59404
Phone: (406) 727-9724
Get Directions

SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Great Falls, MT. 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 1902859515. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shopko Optical 062.

The provider's business location address is:

301 NORTHWEST BYP
GREAT FALLS, MT
ZIP 59404-125
Phone: (406) 727-9724

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 4/24/2008.


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
1156FX1800XTechnician/TechnologistOpticianNo
2152W00000XOptometristNo
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
1000085376MEDICARE PINMONTANA
21111590030MEDICARE ID-TYPE UNSPECIFIED
3DG0079MEDICARE PIN
435491OTHERAVESIS
55695760121MEDICARE NSCMONTANA
617877OTHERMEDICARE
7213121-20OTHEREYEMED
80550576MEDICAIDMONTANA

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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