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SHOPKO OPTICAL 075
NPI 1174576748
Eyewear Supplier in Missoula, MT

Active since May 18, 2006
2510 S RESERVE ST, MISSOULA, MT 59801(406) 721-4646 Get Directions Write a Review

NPPES record last updated: April 24, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Optical 075 NPPES

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

SHOPKO OPTICAL 075 (NPI 1174576748) is a healthcare organization registered as an eyewear supplier in Missoula, Montana 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

NPI1174576748
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2510 S RESERVE STMissoula, MT 59801-7546
Mailing Address2510 S Reserve StMissoula, MT 59801-7546 · (406) 721-4646
Phone(406) 721-4646
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 18, 2006
Last NPPES UpdateApril 24, 2008
✔ NPI 1174576748 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
2510 S RESERVE ST, Missoula, MT 59801
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Other Names 1

Doing Business AsShopko Optical 075

Other Identifiers 9

Other35494Avesis
Medicare NSC5695760120MT
Medicare PIN000085376MT
Other014075Vip
Medicare ID-Type Unspecified1111590016
Medicare PINDG0079
Medicaid0550862MT
Other17878Medicare
Other213121-21Eyemed

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 6

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

THOMAS R FERGUSON O.D.
Optometrist
2510 S RESERVE ST
MISSOULA, MT 59801
Missoula County (406) 721-5925
MRS. REBECCA KATHERINE PITT JACKSON OD
Optometrist
2510 S RESERVE ST
MISSOULA, MT 59801
Missoula County (406) 251-4579
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
2510 S RESERVE ST
MISSOULA, MT 59801
Missoula County (406) 721-3789
GRETCHEN DIERKEN
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
2510 S RESERVE ST
MISSOULA, MT 59801
Missoula County (406) 721-4514
BRETT CURRIE
Pharmacist
2510 S RESERVE ST
MISSOULA, MT 59801
Missoula County (406) 721-3789
DR. GREGORY GENE ZELL O.D.
Optometrist (Corneal and Contact Management)
2510 S RESERVE ST
MISSOULA, MT 59801
Missoula County (406) 721-4646

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 1174576748. It was assigned to this organization in the NPPES registry on May 18, 2006. The provider is doing business as Shopko Optical 075.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2510 S Reserve St, Missoula, MT 59801. The listed phone number is (406) 721-4646.

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 April 24, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.