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SHOPKO OPTICAL 108
NPI 1114970985
Eyewear Supplier in Spanish Fork, UT

Active since May 19, 2006
955 N MAIN ST, SPANISH FORK, UT 84660(801) 798-3557 Get Directions Write a Review

NPPES record last updated: July 10, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 108 NPPES

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

SHOPKO OPTICAL 108 (NPI 1114970985) is a healthcare organization registered as an eyewear supplier in Spanish Fork, Utah 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

NPI1114970985
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address955 N MAIN STSpanish Fork, UT 84660-1150
Mailing Address955 N Main StSpanish Fork, UT 84660-1150 · (801) 798-3557
Phone(801) 798-3557
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJuly 10, 2008
✔ NPI 1114970985 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
955 N MAIN ST, Spanish Fork, UT 84660
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Other Names 1

Doing Business AsShopko Optical 108

Other Identifiers 11

OtherCP2230-52Eyemed
Other17931Medicare
Other42506Davis
Medicare PIN000058212UT
Other014108Vip
Medicare ID-Type Unspecified0154160104
Other35536Avesis
OtherUT04874UT · Noridian Submitter Id
Medicaid410985054-300UT
Medicare NSC5695760038UT
Medicare PINDF0852

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 2

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

SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
955 N MAIN ST
SPANISH FORK, UT 84660
Utah County (801) 798-3529
DR. JERRY DALE CARLSON O.D.
Optometrist
955 N MAIN ST
SPANISH FORK, UT 84660
Utah County (801) 798-3557

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 1114970985. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 108.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 955 N Main St, Spanish Fork, UT 84660. The listed phone number is (801) 798-3557.

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 July 10, 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.