SHOPKO OPTICAL 142
NPI 1629021480
Eyewear Supplier in Fort Madison, IA

Active since May 19, 2006
4810 AVENUE O, FORT MADISON, IA 52627(319) 372-8633 Get Directions Write a Review

NPPES record last updated: January 30, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shopko Optical 142 NPPES

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

SHOPKO OPTICAL 142 (NPI 1629021480) is a healthcare organization registered as an eyewear supplier in Fort Madison, Iowa 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

NPI1629021480
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address4810 AVENUE OFort Madison, IA 52627-9677
Mailing Address4810 Avenue OFort Madison, IA 52627-9677 · (319) 372-8633
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJanuary 30, 2008
NPI 1629021480 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.
4810 AVENUE O, Fort Madison, IA 52627

Other Names 1

Doing Business AsShopko Optical 142

Other Identifiers 9

Medicare PINI17682IA
Other17709Medicare
Medicare NSC5695760070
Other014142Vip
Medicare ID-Type Unspecified1249550009
Medicare PINDF0755
OtherI8499Medicare
OtherCP2521-2Eyemed
Medicaid0252080IA

Other Providers at the Same Location NPPES

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

Pharmacy (Community/Retail Pharmacy)
4810 AVENUE O
FORT MADISON, IA 52627

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 1629021480. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 142.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 4810 Avenue O, Fort Madison, IA 52627. The listed phone number is (319) 372-8633.

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 January 30, 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.