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SHOPKO OPTICAL 109
NPI 1295788065
Eyewear Supplier in Riverdale, UT

Active since May 19, 2006
4060 RIVERDALE RD, RIVERDALE, UT 84405(801) 392-4300 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 109 NPPES

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

SHOPKO OPTICAL 109 (NPI 1295788065) is a healthcare organization registered as an eyewear supplier in Riverdale, 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

NPI1295788065
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address4060 RIVERDALE RDRiverdale, UT 84405-1518
Mailing Address4060 Riverdale RdRiverdale, UT 84405-1518 · (801) 392-4300
Phone(801) 392-4300
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJuly 10, 2008
✔ NPI 1295788065 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
4060 RIVERDALE RD, Riverdale, UT 84405
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Other Names 1

Doing Business AsShopko Optical 109

Other Identifiers 11

Medicaid410985054-408UT
OtherCP2230-48Eyemed
Other014109Vip
OtherUT04871UT · Noridian Submitter Id
Other17932Medicare
Other42510Davis
Other000090125Medicare
Medicare ID-Type Unspecified0154160112
Medicare NSC5695760037UT
Medicare PIN000058212UT
Medicare PINDF0852

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

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)
4060 RIVERDALE RD
RIVERDALE, UT 84405
Weber County (801) 392-6800

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 1295788065. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 109.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 4060 Riverdale Rd, Riverdale, UT 84405. The listed phone number is (801) 392-4300.

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.