SHOPKO OPTICAL 169
NPI 1184677759
Eyewear Supplier in Meridian, ID

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

The NPI number for Shopko Stores Operating Co. LLC is 1184677759. It was assigned to this organization in the NPPES registry on May 18, 2006. The provider is doing business as Shopko Optical 169.

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 18, 2006

3499 E FAIRVIEW AVE, MERIDIAN, ID 83642(208) 884-1362 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Shopko Optical 169 NPPES

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

SHOPKO OPTICAL 169 (NPI 1184677759) is a healthcare organization registered as an eyewear supplier in Meridian, 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

NPI1184677759

Entity TypeOrganization

Primary Taxonomy332H00000X

Legal Business NameSHOPKO STORES OPERATING CO. LLC

Location Address3499 E FAIRVIEW AVEMeridian, ID 83642-5848

Mailing Address3499 E Fairview AveMeridian, ID 83642-5848 · (208) 884-1362

Phone(208) 884-1362

Organization SubpartNo

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

Enumeration DateMay 18, 2006

Last NPPES UpdateAugust 3, 2009

✔ NPI 1184677759 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

3499 E FAIRVIEW AVE, Meridian, ID 83642

Open in Google Maps ↗

Other Names 1

Doing Business AsShopko Optical 169

Other Identifiers 12

Medicaid805542700ID

Other17840Medicare

OtherCP2230-11Eyemed

Medicare ID-Type Unspecified0154160291

Other35448Avesis

Other42568Davis Vision

Medicaid806430108ID

Medicare PINDF0850

Other1593902Medicare

Medicare PIN1369445ID

Other014169Vip

Medicare NSC5695760018ID

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 16

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

JANETTE M BECKWITH

Pharmacist