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SHOPKO OPTICAL 179
NPI 1689835647
Eyewear Supplier in North Branch, MN

Active since June 23, 2008
5630 ST CROIX TRAIL, NORTH BRANCH, MN 55056(651) 674-9951(651) 674-9907 Get Directions Write a Review

NPPES record last updated: June 18, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 179 NPPES

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

SHOPKO OPTICAL 179 (NPI 1689835647) is a healthcare organization registered as an eyewear supplier in North Branch, Minnesota and active in the NPI registry since June 2008. The organization lists Michael Bettiga, Sr. Vice President Health Services, as its authorized official.

NPPES Registry Identity

NPI1689835647
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address5630 ST CROIX TRAILNorth Branch, MN 55056
Mailing Address5630 St Croix TrailNorth Branch, MN 55056 · (651) 674-9951 · Fax (651) 674-9907
Phone(651) 674-9951
Fax(651) 674-9907
Organization SubpartNo
Authorized OfficialMichael BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateJune 23, 2008
Last NPPES UpdateJune 18, 2009
✔ NPI 1689835647 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.
5630 ST CROIX TRAIL, North Branch, MN 55056
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Other Names 1

Doing Business AsShopko Optical 179

Other Identifiers 3

Medicare NSC5695760143
Medicare PINC04276
Medicaid1689835647MN

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)
5630 ST CROIX TRAIL
NORTH BRANCH, MN 55056
Chisago County (651) 674-9956

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 1689835647. It was assigned to this organization in the NPPES registry on June 23, 2008. The provider is doing business as Shopko Optical 179.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 5630 St Croix Trail, North Branch, MN 55056. The listed phone number is (651) 674-9951.

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 June 18, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.