SHOPKO OPTICAL 049
NPI 1124071568
Eyewear Supplier in Aberdeen, SD
About Shopko Optical 049 NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHOPKO OPTICAL 049 (NPI 1124071568) is a healthcare organization registered as an eyewear supplier in Aberdeen, South Dakota 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
Specialties & Licenses
Other Names 1
Other Identifiers 8
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shopko Optical 049 is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Shopko Optical 049, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 1124071568. It was assigned to this organization in the NPPES registry on May 18, 2006. The provider is doing business as Shopko Optical 049.
Where is Shopko Stores Operating Co. LLC located?
Shopko Stores Operating Co. LLC is located at 500 N Hwy 281, Aberdeen, SD 57401. The listed phone number is (605) 225-7677.
What is Shopko Stores Operating Co. LLC's specialty?
The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.
Is Shopko Stores Operating Co. LLC enrolled in Medicare?
Yes. Shopko Stores Operating Co. LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Shopko Stores Operating Co. LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Optometry, reassign their Medicare billing to Shopko Stores Operating Co. LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Shopko Stores Operating Co. LLC was last updated on February 11, 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.
# Shopko Optical 049 · NPI 1124071568
Eyewear Supplier organization in Aberdeen, South Dakota. Organization record, active in the CMS NPPES registry since May 18, 2006.
## Identity
- **NPI:** 1124071568 (Entity type: Organization)
- **Enumerated:** May 18, 2006
- **Primary specialty:** Eyewear Supplier · taxonomy 332H00000X
- **Legal business name:** Shopko Stores Operating Co. Llc
- **Organization subpart:** No
- **Authorized official:** Michael Bettiga, SR. VICE PRESIDENT HEALTH SERVICES
## Practice location
- **Address:** 500 N HWY 281, Aberdeen, SD 57401-1821
- **Phone:** (605) 225-7677
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians (Optometry) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 11, 2008
- **Other identifiers:** Medicare NSC 5695760069 (SD); Medicare PIN S101047 (SD); Other 213121-26; and 5 more
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Source: [NPI Profile](https://npiprofile.com/npi/1124071568) · Data from the CMS NPPES public registry.