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SHOPKO OPTICAL 095
NPI 1477505485
Eyewear Supplier in Boise, ID

Active since May 17, 2006
2655 BROADWAY AVE, BOISE, ID 83706(208) 345-8812 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Shopko Optical 095 NPPES

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

SHOPKO OPTICAL 095 (NPI 1477505485) is a healthcare organization registered as an eyewear supplier in Boise, 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

NPI1477505485
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2655 BROADWAY AVEBoise, ID 83706-4721
Mailing Address2655 Broadway AveBoise, ID 83706-4721 · (208) 345-8812
Phone(208) 345-8812
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateAugust 3, 2009
✔ NPI 1477505485 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
2655 BROADWAY AVE, Boise, ID 83706
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Other Names 1

Doing Business AsShopko Optical 095

Other Identifiers 12

Other42577Davis Vision
Other410985054-4095Uwg
Other014095Vip
Medicare ID-Type Unspecified1111590017
Medicare NSC5695760089ID
Other17839Medicare
Other1379405Medicare
Medicare PINDF0850
Other213121-3Eyemed
Medicaid000309600ID
Medicaid806430107ID
Medicare PIN1369445ID

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

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)
2655 BROADWAY AVE
BOISE, ID 83706
Ada County (208) 345-8728

Frequently Asked Questions

What is SHOPKO STORES OPERATING CO. LLC's NPI number?

The NPI number assigned to this healthcare provider is 1477505485, enumerated as an "organization" on May 17, 2006.

Where is the provider located?

The provider is located at 2655 BROADWAY AVE BOISE, ID 83706 and the phone number is (208) 345-8812.

What is the provider's specialty?

Eyewear Supplier with taxonomy code 332H00000X.

What insurance does SHOPKO STORES OPERATING CO. LLC accept?

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.