SHOPKO OPTICAL 061
NPI 1063465789
Eyewear Supplier in Saint Cloud, MN

Active since May 17, 2006
501 HIGHWAY 10 SE, SAINT CLOUD, MN 56304(320) 253-4695 Get Directions Write a Review

NPPES record last updated: April 15, 2008. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Shopko Optical 061 NPPES

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

SHOPKO OPTICAL 061 (NPI 1063465789) is a healthcare organization registered as an eyewear supplier in Saint Cloud, Minnesota 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

NPI1063465789
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address501 HIGHWAY 10 SESaint Cloud, MN 56304-1250
Mailing Address501 Highway 10 SeSaint Cloud, MN 56304-1250 · (320) 253-4695
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateApril 15, 2008
NPI 1063465789 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.

501 HIGHWAY 10 SE, Saint Cloud, MN 56304

Other Names 1

Doing Business AsShopko Optical 061

Other Identifiers 15

Other42497Davis
Other35480Avesis
Medicare ID-Type Unspecified1111590022
Other014061Vip
Medicare NSC5695760083MN
Other17832Medicare
Other21527Mn Health Partners
Other55306HAMn Ma First Plan Of Mn
Other20019120524Mn Ma Primewest Health
Other410985054-4061National Vision Admin.
Medicare PINC04276
Other2100301Mn Ma Medica Choice Care
Other213121-17Eyemed
Other26887SHMn Ma First Plan Of Mn
Medicare PINDF0849

Other Providers at the Same Location NPPES

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

Pharmacy (Community/Retail Pharmacy)
501 HIGHWAY 10 SE
SAINT CLOUD, MN 56304

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1063465789, enumerated as an "organization" on May 17, 2006.

The provider is located at 501 HIGHWAY 10 SE SAINT CLOUD, MN 56304 and the phone number is (320) 253-4695.

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.