SHOPKO OPTICAL 063
NPI 1336191436
Eyewear Supplier in Chubbuck, ID

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

The NPI number for Shopko Stores Operating Co. LLC is 1336191436. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 063.

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 17, 2006

4215 YELLOWSTONE AVE, CHUBBUCK, ID 83202(208) 237-6822 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Shopko Optical 063 NPPES

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

SHOPKO OPTICAL 063 (NPI 1336191436) is a healthcare organization registered as an eyewear supplier in Chubbuck, 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

NPI1336191436

Entity TypeOrganization

Primary Taxonomy332H00000X

Legal Business NameSHOPKO STORES OPERATING CO. LLC

Location Address4215 YELLOWSTONE AVEChubbuck, ID 83202-2419

Mailing Address4215 Yellowstone AveChubbuck, ID 83202-2419 · (208) 237-6822

Phone(208) 237-6822

Organization SubpartNo

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

Enumeration DateMay 17, 2006

Last NPPES UpdateAugust 3, 2009

✔ NPI 1336191436 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

4215 YELLOWSTONE AVE, Chubbuck, ID 83202

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Other Names 1

Doing Business AsShopko Optical 063

Other Identifiers 12

Other17712Medicare

Medicare ID-Type Unspecified0154160015

Medicare PINDF0850

Medicare PIN1369445ID

OtherCP2230-10Eyemed

Other1593901Medicare

Medicare NSC5695760013ID

Medicaid805180700ID

Other014063Vip

Medicaid806430100ID

Medicaid000309500ID

Other42499Davis Vision

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.

STEPHEN C SCHIERS RPH

Pharmacist