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SHOPKO STORES OPERATING CO. LLC NPI 1083667406


NPI Information

NPI: 1083667406
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 141

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
313 N ROOSEVELT AVE
BURLINGTON, IA
ZIP 52601
Phone: (319) 758-9145
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Burlington, 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 1083667406. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Optical 141.

The provider's business location address is:

313 N ROOSEVELT AVE
BURLINGTON, IA
ZIP 52601-757
Phone: (319) 758-9145

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
15695760073MEDICARE NSC
2DF0755MEDICARE PIN
3I17682MEDICARE PINIOWA
435436OTHERAVESIS
5CP2521-1OTHEREYEMED
6014141OTHERVIP
717698OTHERMEDICARE
81249550006MEDICARE ID-TYPE UNSPECIFIED
9I3516OTHERMEDICARE

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: 5/5/2024
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