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SHOPKO OPTICAL 050
NPI 1013960723
Eyewear Supplier in Fond Du Lac, WI

Active since May 17, 2006
616 W JOHNSON ST, FOND DU LAC, WI 54935(920) 921-8290 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 050 NPPES

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

SHOPKO OPTICAL 050 (NPI 1013960723) is a healthcare organization registered as an eyewear supplier in Fond Du Lac, Wisconsin 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

NPI1013960723
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address616 W JOHNSON STFond Du Lac, WI 54935-3134
Mailing Address616 W Johnson StFond Du Lac, WI 54935-3134 · (920) 921-8290
Phone(920) 921-8290
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 11, 2008
✔ NPI 1013960723 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEyewear SupplierSuppliers
Taxonomy Code332H00000X
Definition
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
616 W JOHNSON ST, Fond Du Lac, WI 54935
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Other Names 1

Doing Business AsShopko Optical 050

Other Identifiers 10

Other410985054-4050Nva
OtherCP2230-3Eyemed
Medicare ID-Type Unspecified0154160133
Medicaid38426900WI
Medicare NSC5695760109WI
Other014050Vip
Other42597Davis
Other35560Avesis
Other17654Medicare
Medicare PINDF0804

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.

JOHN M DRIEDRIC PHARMD
Pharmacist
616 W JOHNSON ST
FOND DU LAC, WI 54935
Fond Du Lac County (920) 921-5490
MYNY V YANG RPH
Pharmacist
616 W JOHNSON ST
FOND DU LAC, WI 54935
Fond Du Lac County (920) 921-5490
STEVEN D HENSLIN R.PH.
Pharmacist
616 W JOHNSON ST
FOND DU LAC, WI 54935
Fond Du Lac County (920) 921-5490
DR. CARIN M LACOUNT OD
Optometrist
616 W JOHNSON ST
FOND DU LAC, WI 54935
Fond Du Lac County (920) 921-8290
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
616 W JOHNSON ST
FOND DU LAC, WI 54935
Fond Du Lac County (920) 921-5490

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 1013960723. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 050.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 616 W Johnson St, Fond Du Lac, WI 54935. The listed phone number is (920) 921-8290.

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 February 11, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.