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SHOPKO OPTICAL 079
NPI 1386697092
Eyewear Supplier in Wausau, WI

Active since May 17, 2006
200 S 18TH AVE, WAUSAU, WI 54401(715) 842-8040 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Optical 079 NPPES

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

SHOPKO OPTICAL 079 (NPI 1386697092) is a healthcare organization registered as an eyewear supplier in Wausau, Wisconsin 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

NPI1386697092
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address200 S 18TH AVEWausau, WI 54401-4252
Mailing Address200 S 18th AveWausau, WI 54401-4252 · (715) 842-8040
Phone(715) 842-8040
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 11, 2008
✔ NPI 1386697092 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEyewear SupplierSuppliers
Taxonomy Code332H00000X
Definition
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
200 S 18TH AVE, Wausau, WI 54401
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Other Names 1

Doing Business AsShopko Optical 079

Other Identifiers 11

Other014079Vip
Other17670Medicare
Other410985054-4079Nva
OtherCP2230-98Eyemed
Other35599Avesis
Medicare ID-Type Unspecified0154160096
Medicare NSC5695760058WI
Other87857Medicare
Other42534Davis
Medicaid38440500WI
Medicare PINDF0804

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.

BUSISIWE ROSE VANDRIEL O.D.
Optometrist
200 S 18TH AVE
WAUSAU, WI 54401
Marathon County (715) 842-8040
DR. ERIN RENEE DAGGETT O.D.
Optometrist
200 S 18TH AVE
WAUSAU, WI 54401
Marathon County (715) 842-8040
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
200 S 18TH AVE
WAUSAU, WI 54401
Marathon County (715) 842-7737
MR. PATRICK JOSEPH STEFFECK RPH
Pharmacist
200 S 18TH AVE
WAUSAU, WI 54401
Marathon County (715) 842-7737
LORI M EVANS
Nurse Practitioner (Family)
200 S 18TH AVE
WAUSAU, WI 54401
Marathon County (715) 842-3084

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 1386697092. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 079.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 200 S 18th Ave, Wausau, WI 54401. The listed phone number is (715) 842-8040.

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 February 11, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.