SHOPKO OPTICAL 051
NPI 1053363010
Eyewear Supplier in Fort Atkinson, WI

Active since May 17, 2006
1425 JANESVILLE AVE, FORT ATKINSON, WI 53538(920) 563-2171 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Shopko Optical 051 NPPES

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

SHOPKO OPTICAL 051 (NPI 1053363010) is a healthcare organization registered as an eyewear supplier in Fort Atkinson, 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

NPI1053363010
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address1425 JANESVILLE AVEFort Atkinson, WI 53538-2705
Mailing Address1425 Janesville AveFort Atkinson, WI 53538-2705 · (920) 563-2171
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 11, 2008
NPI 1053363010 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.

1425 JANESVILLE AVE, Fort Atkinson, WI 53538

Other Names 1

Doing Business AsShopko Optical 051

Other Identifiers 10

Other35561Avesis
OtherCP2230-67Eyemed
Other42598Davis
Medicaid38450700WI
Medicare PINDF0804
Other17655Medicare
Other410985054-4051Nva
Other014051Vip
Medicare ID-Type Unspecified0154160106
Medicare NSC5695760067WI

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.

Pharmacy (Community/Retail Pharmacy)
1425 JANESVILLE AVE
FORT ATKINSON, WI 53538
Optometrist
1425 JANESVILLE AVE
FORT ATKINSON, WI 53538
Pharmacist
1425 JANESVILLE AVE
FORT ATKINSON, WI 53538
Pharmacist
1425 JANESVILLE AVE
FORT ATKINSON, WI 53538

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1053363010, enumerated as an "organization" on May 17, 2006.

The provider is located at 1425 JANESVILLE AVE FORT ATKINSON, WI 53538 and the phone number is (920) 563-2171.

Eyewear Supplier with taxonomy code 332H00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.