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SHOPKO OPTICAL 107
NPI 1205889078
Eyewear Supplier in Bountiful, UT

Active since May 19, 2006
190 S 500 W, BOUNTIFUL, UT 84010(801) 295-9200 Get Directions Write a Review

NPPES record last updated: July 10, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Optical 107 NPPES

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

SHOPKO OPTICAL 107 (NPI 1205889078) is a healthcare organization registered as an eyewear supplier in Bountiful, 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

NPI1205889078
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address190 S 500 WBountiful, UT 84010-8729
Mailing Address190 S 500 WBountiful, UT 84010-8729 · (801) 295-9200
Phone(801) 295-9200
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJuly 10, 2008
✔ NPI 1205889078 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
190 S 500 W, Bountiful, UT 84010
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Other Names 1

Doing Business AsShopko Optical 107

Other Identifiers 11

OtherCP2230-53Eyemed
Other014107Vip
OtherUT04877UT · Noridian Submitter Id
Other42591Davis
Medicare PIN000058212UT
Medicaid410985054-229UT
Medicare PINDF0852
Other35537Avesis
Medicare ID-Type Unspecified0154160240
Other17929Medicare
Medicare NSC5695760039UT

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 3

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)
190 S 500 W
BOUNTIFUL, UT 84010
Davis County (801) 295-6900
SHAWN PAGE MURRAY O.D.
Optometrist
190 S 500 W
BOUNTIFUL, UT 84010
Davis County (801) 295-9200
MR. GARY ARVEL HALE R.PH
Pharmacist
190 S 500 W
BOUNTIFUL, UT 84010
Davis County (801) 295-6900

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 1205889078. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 107.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 190 S 500 W, Bountiful, UT 84010. The listed phone number is (801) 295-9200.

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 with the weekly NPPES data releases published by CMS.