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SHOPKO STORES OPERATING CO. LLC NPI 1033161419


NPI Information

NPI: 1033161419
Provider Name: SHOPKO STORES OPERATING CO. LLC

Doing Business As: SHOPKO OPTICAL 113

Classification: Eyewear Supplier - 332H00000X
Entity Type: Organization
Address:
5500 MARTIN WAY E
LACEY, WA
ZIP 98516
Phone: (360) 456-4532
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SHOPKO STORES OPERATING CO. LLC is an eyewear supplier in Lacey, WA. 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 1033161419. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shopko Optical 113.

The provider's business location address is:

5500 MARTIN WAY E
LACEY, WA
ZIP 98516-326
Phone: (360) 456-4532

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 6/5/2009.


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
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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12016293MEDICAIDWASHINGTON
22020667MEDICAIDWASHINGTON
3014113OTHERVIP
4WA09205OTHERWASHINGTONNORIDIAN SUBMITTER ID
5G8855125OTHERMEDICARE
6DF1015MEDICARE PIN
7G8860390MEDICARE PINWASHINGTON
80154160170MEDICARE ID-TYPE UNSPECIFIED
917676OTHERMEDICARE
10CP2230-57OTHEREYEMED
115695760115MEDICARE NSCWASHINGTON

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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