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SHOPKO OPTICAL 064
NPI 1164475752
Eyewear Supplier in Nampa, ID

Active since May 18, 2006
2100 CALDWELL BLVD, NAMPA, ID 83651(208) 466-6895 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 064 NPPES

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

SHOPKO OPTICAL 064 (NPI 1164475752) is a healthcare organization registered as an eyewear supplier in Nampa, Idaho 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

NPI1164475752
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2100 CALDWELL BLVDNampa, ID 83651-1510
Mailing Address2100 Caldwell BlvdNampa, ID 83651-1510 · (208) 466-6895
Phone(208) 466-6895
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 18, 2006
Last NPPES UpdateAugust 3, 2009
✔ NPI 1164475752 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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 ListedTechnician/Technologist · OpticianTaxonomy 156FX1800X
2100 CALDWELL BLVD, Nampa, ID 83651
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Other Names 1

Doing Business AsShopko Optical 064

Other Identifiers 13

Medicare PIN1369445ID
Other213121-7Eyemed
Medicare ID-Type Unspecified1111590020
Other17713Medicare
Medicare PINDF0850
Other014064Vip
Other42500Davis Vision
Medicaid000309900ID
Other35449Avesis
Medicaid806430101ID
Other1379400Medicare
Other410985054-4064Uwg
Medicare NSC5695760006ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

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)
2100 CALDWELL BLVD
NAMPA, ID 83651
Canyon County (208) 466-9616
TIMOTHY F SWAIN RPH, PHARM D
Pharmacist
2100 CALDWELL BLVD
NAMPA, ID 83651
Canyon County (208) 466-9616
MR. MARK MATTHEW MCKELL O.D.
Optometrist
2100 CALDWELL BLVD
NAMPA, ID 83651
Canyon County (208) 466-6895
DR. JOY GAYLE JOHNSON O.D.
Optometrist
2100 CALDWELL BLVD
NAMPA, ID 83651
Canyon County (208) 465-5542
THOMAS JOSEPH STATZ
Pharmacist
2100 CALDWELL BLVD
NAMPA, ID 83651
Canyon County (208) 466-9616

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 1164475752. It was assigned to this organization in the NPPES registry on May 18, 2006. The provider is doing business as Shopko Optical 064.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2100 Caldwell Blvd, Nampa, ID 83651. The listed phone number is (208) 466-6895.

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 August 3, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.