SHOPKO OPTICAL 174
NPI 1073565180
Eyewear Supplier in Peoria, IL

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

The NPI number for Shopko Stores Operating Co. LLC is 1073565180. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 174.

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

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

Active since May 17, 2006

2323 W PIONEER PKWY, PEORIA, IL 61615(309) 691-4815 Get Directions Write a Review

NPPES record last updated: September 28, 2007. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Shopko Optical 174 NPPES

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

SHOPKO OPTICAL 174 (NPI 1073565180) is a healthcare organization registered as an eyewear supplier in Peoria, Illinois 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

NPI1073565180

Entity TypeOrganization

Primary Taxonomy332H00000X

Legal Business NameSHOPKO STORES OPERATING CO. LLC

Location Address2323 W PIONEER PKWYPeoria, IL 61615-1833

Mailing Address2323 W Pioneer PkwyPeoria, IL 61615-1833 · (309) 691-4815

Phone(309) 691-4815

Organization SubpartNo

Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297

Enumeration DateMay 17, 2006

Last NPPES UpdateSeptember 28, 2007

✔ NPI 1073565180 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.

2323 W PIONEER PKWY, Peoria, IL 61615

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Other Names 1

Doing Business AsShopko Optical 174

Other Identifiers 7

Other17691Medicare

Other014174Vip

OtherCP230-16Eyemed

Other42575Davis

Other35458Avesis

Medicare PIN213638

Medicare ID-Type Unspecified0154160297

Other Providers at the Same Location NPPES

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

SHOPKO STORES OPERATING CO. LLC

Durable Medical Equipment & Medical Supplies

2323 W PIONEER PKWY
PEORIA, IL 61615

Peoria County (309) 691-4682

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 1073565180. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 174.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2323 W Pioneer Pkwy, Peoria, IL 61615. The listed phone number is (309) 691-4815.

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 September 28, 2007. 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.