SHOPKO OPTICAL 105
NPI 1396798161
Eyewear Supplier in Orem, UT

Active since May 19, 2006
125 S STATE ST, OREM, UT 84058(801) 225-4700 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 105 NPPES

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

SHOPKO OPTICAL 105 (NPI 1396798161) is a healthcare organization registered as an eyewear supplier in Orem, 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

NPI1396798161
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address125 S STATE STOrem, UT 84058-5419
Mailing Address125 S State StOrem, UT 84058-5419 · (801) 225-4700
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJuly 10, 2008
NPI 1396798161 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
125 S STATE ST, Orem, UT 84058

Other Names 1

Doing Business AsShopko Optical 105

Other Identifiers 11

OtherUT04884UT · Noridian Submitter Id
Medicaid410985054-196UT
Medicare PIN000058212UT
Other42586Davis
Other014105Vip
Medicare NSC5695760035
Medicare PINDF0852
Other35528Avesis
Medicare ID-Type Unspecified0154160068
OtherCP2230-46Eyemed
Other17928Medicare

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 2

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

Pharmacy (Community/Retail Pharmacy)
125 S STATE ST
OREM, UT 84058
Optometrist
125 S STATE ST
OREM, UT 84058

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 1396798161. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 105.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 125 S State St, Orem, UT 84058. The listed phone number is (801) 225-4700.

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.