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SHOPKO OPTICAL 104
NPI 1700839545
Eyewear Supplier in Brigham City, UT

Active since May 19, 2006
747 S MAIN ST, BRIGHAM CITY, UT 84302(435) 723-1800 Get Directions Write a Review

NPPES record last updated: July 10, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Optical 104 NPPES

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

SHOPKO OPTICAL 104 (NPI 1700839545) is a healthcare organization registered as an eyewear supplier in Brigham 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

NPI1700839545
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address747 S MAIN STBrigham City, UT 84302-3359
Mailing Address747 S Main StBrigham City, UT 84302-3359 · (435) 723-1800
Phone(435) 723-1800
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJuly 10, 2008
✔ NPI 1700839545 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
747 S MAIN ST, Brigham City, UT 84302
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Other Names 1

Doing Business AsShopko Optical 104

Other Identifiers 10

Medicaid410985054-165UT
Medicare PINDF0852
OtherUT04883UT · Noridian Submitter Id
Other014104Vip
Other35524Avesis
OtherCP2230-41Eyemed
Medicare ID-Type Unspecified0154160241
Medicare NSC5695760031
Other17927Medicare
Medicare PIN000058212UT

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. SCOTT ROBERTS HADERLIE O.D.
Optometrist
747 S MAIN ST
BRIGHAM CITY, UT 84302
Box Elder County (435) 723-1800
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
747 S MAIN ST
BRIGHAM CITY, UT 84302
Box Elder County (435) 723-1600

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 1700839545. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 104.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 747 S Main St, Brigham City, UT 84302. The listed phone number is (435) 723-1800.

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 with the weekly NPPES data releases published by CMS.