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SHOPKO OPTICAL 113
NPI 1033161419
Eyewear Supplier in Lacey, WA

Active since May 16, 2006
5500 MARTIN WAY E, LACEY, WA 98516(360) 456-4532 Get Directions Write a Review

NPPES record last updated: June 5, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shopko Optical 113 NPPES

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

SHOPKO OPTICAL 113 (NPI 1033161419) is a healthcare organization registered as an eyewear supplier in Lacey, Washington 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

NPI1033161419
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address5500 MARTIN WAY ELacey, WA 98516-6326
Mailing Address5500 Martin Way ELacey, WA 98516-6326 · (360) 456-4532
Phone(360) 456-4532
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 16, 2006
Last NPPES UpdateJune 5, 2009
✔ NPI 1033161419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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 ListedOptometristTaxonomy 152W00000X
Also ListedTechnician/Technologist · OpticianTaxonomy 156FX1800X
5500 MARTIN WAY E, Lacey, WA 98516
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Other Names 1

Doing Business AsShopko Optical 113

Other Identifiers 11

Medicaid2016293WA
Medicaid2020667WA
Other014113Vip
OtherWA09205WA · Noridian Submitter Id
OtherG8855125Medicare
Medicare PINDF1015
Medicare PING8860390WA
Medicare ID-Type Unspecified0154160170
Other17676Medicare
OtherCP2230-57Eyemed
Medicare NSC5695760115WA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

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

MR. GEORGE CHRISTIAN WANG PHARMACIST
Pharmacist
5500 MARTIN WAY E
LACEY, WA 98516
Thurston County (360) 456-4057
MICHELLE TERI KAUTZMANN
Pharmacist
5500 MARTIN WAY E
LACEY, WA 98516
Thurston County (360) 456-4057
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
5500 MARTIN WAY E
LACEY, WA 98516
Thurston County (360) 456-4057
MR. KENNETH R PETERSEN RPH
Pharmacist
5500 MARTIN WAY E
LACEY, WA 98516
Thurston County (360) 456-4057

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 1033161419. It was assigned to this organization in the NPPES registry on May 16, 2006. The provider is doing business as Shopko Optical 113.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 5500 Martin Way E, Lacey, WA 98516. The listed phone number is (360) 456-4532.

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 June 5, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.