1. Home
  2. Directory
  3. Utah
  4. Logan
  5. Eyewear Supplier
  6. NPI Profile

SHOPKO OPTICAL 091
NPI 1609828136
Eyewear Supplier in Logan, UT

Active since May 16, 2006
1341 N MAIN ST, LOGAN, UT 84341(435) 753-0700 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 091 NPPES

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

SHOPKO OPTICAL 091 (NPI 1609828136) is a healthcare organization registered as an eyewear supplier in Logan, 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

NPI1609828136
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address1341 N MAIN STLogan, UT 84341-2221
Mailing Address1341 N Main StLogan, UT 84341-2221 · (435) 753-0700
Phone(435) 753-0700
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 16, 2006
Last NPPES UpdateJuly 10, 2008
✔ NPI 1609828136 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
1341 N MAIN ST, Logan, UT 84341
Open in Google Maps ↗

Other Names 1

Doing Business AsShopko Optical 091

Other Identifiers 11

Other17924Medicare
Other42567Davis
Medicaid410985054-148UT
Medicare PIN000058212UT
Other35721Avesis
OtherUT04878UT · Noridian Submitter Id
Medicare PINDF0852
Other014091Vip
Medicare ID-Type Unspecified0154160155
OtherCP2230-43Eyemed
Medicare NSC5695760044UT

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.

DR. ALAN HASTINGS O.D.
Optometrist
1341 N MAIN ST
LOGAN, UT 84341
Cache County (435) 753-0700
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
1341 N MAIN ST
LOGAN, UT 84341
Cache County (435) 753-2700

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 1609828136. It was assigned to this organization in the NPPES registry on May 16, 2006. The provider is doing business as Shopko Optical 091.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 1341 N Main St, Logan, UT 84341. The listed phone number is (435) 753-0700.

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.