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SHOPKO OPTICAL 110
NPI 1568415339
Eyewear Supplier in Salt Lake City, UT

Active since May 19, 2006
2290 S 1300 E, SALT LAKE CITY, UT 84106(801) 467-8989 Get Directions Write a Review

NPPES record last updated: July 10, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 110 NPPES

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

SHOPKO OPTICAL 110 (NPI 1568415339) is a healthcare organization registered as an eyewear supplier in Salt Lake City, 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

NPI1568415339
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2290 S 1300 ESalt Lake City, UT 84106-2831
Mailing Address2290 S 1300 ESalt Lake City, UT 84106-2831 · (801) 467-8989
Phone(801) 467-8989
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJuly 10, 2008
✔ NPI 1568415339 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
2290 S 1300 E, Salt Lake City, UT 84106
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Other Names 1

Doing Business AsShopko Optical 110

Other Identifiers 12

Medicare NSC5695760036UT
Other17933Medicare
Medicaid410985054-246UT
OtherCP2230-50Eyemed
Medicare PINDF0852
Other014110Vip
OtherUT03960UT · Noridian Submitter Id
Medicare ID-Type Unspecified0154160174
Other410985054-4110National Vision Admin
Medicare PIN000058212UT
Other35534Avesis
Other42512Davis

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.

SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
2290 S 1300 E
SALT LAKE CITY, UT 84106
Salt Lake County (801) 467-8900
DR. DANIEL MARK WEIR O.D.
Optometrist
2290 S 1300 E
SALT LAKE CITY, UT 84106
Salt Lake County (801) 261-8263

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 1568415339. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 110.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2290 S 1300 E, Salt Lake City, UT 84106. The listed phone number is (801) 467-8989.

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 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.