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SHOPKO OPTICAL 072
NPI 1003869678
Eyewear Supplier in Lewiston, ID

Active since May 18, 2006
2120 THAIN GRADE, LEWISTON, ID 83501(208) 746-1050 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Optical 072 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHOPKO OPTICAL 072 (NPI 1003869678) is a healthcare organization registered as an eyewear supplier in Lewiston, Idaho and active in the NPI registry since May 2006. The organization lists Michael J Bettiga, Sr. Vice President Health Services, as its authorized official.

NPPES Registry Identity

NPI1003869678
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2120 THAIN GRADELewiston, ID 83501-4105
Mailing Address2120 Thain GradeLewiston, ID 83501-4105 · (208) 746-1050
Phone(208) 746-1050
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 18, 2006
Last NPPES UpdateAugust 3, 2009
✔ NPI 1003869678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEyewear SupplierSuppliers
Taxonomy Code332H00000X
Definition

An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Also ListedTechnician/Technologist · OpticianTaxonomy 156FX1800X
2120 THAIN GRADE, Lewiston, ID 83501
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Other Names 1

Doing Business AsShopko Optical 072

Other Identifiers 11

Other213121-6Eyemed
Medicaid806430106ID
Medicare PIN1369445ID
Medicare PINDF0850
Medicare ID-Type Unspecified1111590032
Medicaid000310200ID
Other17838Medicare
Other1379404Medicare
Other014072Vip
Other35447Avesis
Medicare NSC5695760098ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DANIEL NILE EVANS O.D.
Optometrist
2120 THAIN GRADE
LEWISTON, ID 83501
Nez Perce County (208) 746-1050
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
2120 THAIN GRADE
LEWISTON, ID 83501
Nez Perce County (208) 746-1044
DR. NEELY R DAVIS PHARMD
Pharmacist
2120 THAIN GRADE
LEWISTON, ID 83501
Nez Perce County (208) 746-1044
MARGERET ROY
Pharmacist
2120 THAIN GRADE
LEWISTON, ID 83501
Nez Perce County (208) 746-1044
BRENDA LYNN OFFERDAHL O.D.
Optometrist
2120 THAIN GRADE
LEWISTON, ID 83501
Nez Perce County (208) 746-1050

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shopko Stores Operating Co. LLC's NPI number?

The NPI number for Shopko Stores Operating Co. LLC is 1003869678. It was assigned to this organization in the NPPES registry on May 18, 2006. The provider is doing business as Shopko Optical 072.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2120 Thain Grade, Lewiston, ID 83501. The listed phone number is (208) 746-1050.

What is Shopko Stores Operating Co. LLC's specialty?

The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.

When was this NPI record last updated?

The NPPES record for Shopko Stores Operating Co. LLC was last updated on August 3, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.