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SHOPKO OPTICAL 067
NPI 1821040973
Eyewear Supplier in Twin Falls, ID

Active since May 17, 2006
1649 POLELINE RD E, TWIN FALLS, ID 83301(208) 734-3908 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 067 NPPES

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

SHOPKO OPTICAL 067 (NPI 1821040973) is a healthcare organization registered as an eyewear supplier in Twin Falls, Idaho 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

NPI1821040973
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address1649 POLELINE RD ETwin Falls, ID 83301-3592
Mailing Address1649 Poleline Rd ETwin Falls, ID 83301-3592 · (208) 734-3908
Phone(208) 734-3908
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateAugust 3, 2009
✔ NPI 1821040973 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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 ListedTechnician/Technologist · OpticianTaxonomy 156FX1800X
1649 POLELINE RD E, Twin Falls, ID 83301
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Other Names 1

Doing Business AsShopko Optical 067

Other Identifiers 10

Other17835Medicare
Other213121-8Eyemed
Medicaid000309700ID
Medicare PINDF0850
Medicare PIN1369445ID
Medicaid806430103ID
Medicare ID-Type Unspecified1111590013
Other1379402Medicare
Other014067Vip
Medicare NSC5695760029ID

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

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)
1649 POLELINE RD E
TWIN FALLS, ID 83301
Twin Falls County (208) 734-3791

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 1821040973. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 067.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 1649 Poleline Rd E, Twin Falls, ID 83301. The listed phone number is (208) 734-3908.

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 August 3, 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.