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SHOPKO OPTICAL 014
NPI 1396797411
Eyewear Supplier in Beaver Dam, WI

Active since May 17, 2006
822 PARK AVE, BEAVER DAM, WI 53916(920) 887-3791 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 014 NPPES

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

SHOPKO OPTICAL 014 (NPI 1396797411) is a healthcare organization registered as an eyewear supplier in Beaver Dam, 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

NPI1396797411
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address822 PARK AVEBeaver Dam, WI 53916-2266
Mailing Address822 Park AveBeaver Dam, WI 53916-2266 · (920) 887-3791
Phone(920) 887-3791
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 11, 2008
✔ NPI 1396797411 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.
822 PARK AVE, Beaver Dam, WI 53916
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Other Names 1

Doing Business AsShopko Optical 014

Other Identifiers 9

OtherCP2230-61Eyemed
Other014014Vip
Other42590Davis
Medicaid38422300WI
Other17641Medicare
Other410985054-4014Nva
Medicare NSC5695760085WI
Medicare PINDF0804
Medicare ID-Type Unspecified0154160186

Other Providers at the Same Location NPPES 8

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

MIKE LEAHAN RPH
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7511
JESSAMYN KOVACS O.D.
Optometrist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791
MR. ANTHONY THOMAS BRIDGEMAN RPH
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (608) 887-7511
DR. BRIAN L SCHROEDL O.D.
Optometrist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791
DR. MICHAEL DULL II PHARMD
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7511
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7461
MR. KEVIN DALE WRIGHT RPH
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7461
DR. MARK E. JAMES O.D.
Optometrist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791

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 1396797411. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 014.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 822 Park Ave, Beaver Dam, WI 53916. The listed phone number is (920) 887-3791.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.