SHOPKO OPTICAL 068
NPI 1952354540
Eyewear Supplier in Idaho Falls, ID

Active since May 18, 2006
800 E 17TH ST, IDAHO FALLS, ID 83404(208) 522-3795 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Optical 068 NPPES

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

SHOPKO OPTICAL 068 (NPI 1952354540) is a healthcare organization registered as an eyewear supplier in Idaho 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

NPI1952354540
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address800 E 17TH STIdaho Falls, ID 83404-6151
Mailing Address800 E 17th StIdaho Falls, ID 83404-6151 · (208) 522-3795
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 18, 2006
Last NPPES UpdateAugust 3, 2009
NPI 1952354540 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
800 E 17TH ST, Idaho Falls, ID 83404

Other Names 1

Doing Business AsShopko Optical 068

Other Identifiers 11

Medicare ID-Type Unspecified1111590040
Other17836Medicare
Medicare NSC5695760063ID
Medicare PIN1369445ID
Other014068Vip
Other213121-5Eyemed
Other42505Davis Vision
Medicare PINDF0850
Medicaid000310100ID
Other1379406Medicare
Medicaid806430104ID

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 6

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

Pharmacist
800 E 17TH ST
IDAHO FALLS, ID 83404
Pharmacist
800 E 17TH ST
IDAHO FALLS, ID 83404
Pharmacist
800 E 17TH ST
IDAHO FALLS, ID 83404
Pharmacy (Community/Retail Pharmacy)
800 E 17TH ST
IDAHO FALLS, ID 83404
Pharmacist
800 E 17TH ST
IDAHO FALLS, ID 83404
Optometrist
800 E 17TH ST
IDAHO FALLS, ID 83404

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 1952354540. It was assigned to this organization in the NPPES registry on May 18, 2006. The provider is doing business as Shopko Optical 068.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 800 E 17th St, Idaho Falls, ID 83404. The listed phone number is (208) 522-3795.

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 with the weekly NPPES data releases published by CMS.