Shopko Optical 063

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 063 is an health care organization with primary practice located at 4215 Yellowstone Ave , Chubbuck ID 83202-2419. The organization recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optician, Suppliers / Eyewear Supplier (Equipment, not the service). Suppliers / Eyewear Supplier (Equipment, not the service) is the primary health care specialty. Shopko Stores Operating Co. Llc can be contacted via phone (208) 237-6822, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
4215 Yellowstone Ave Chubbuck ID 83202-2419
Phone: (208) 237-6822
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael J RPH
Phone: (920) 429-4297

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optician 156FX1800X
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X

Profile Details

NPI number 1336191436
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 063
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 2006
Last updated Aug 3rd, 2009 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336191436 NPPES
Other 17712 MEDICARE
Other CP2230-10 MEDICARE
MEDICAID 000309500 MEDICARE
Other 42499 MEDICARE
MEDICAID 806430100 MEDICARE
Other 014063 MEDICARE
Other 1593901 MEDICARE
MEDICAID 805180700 MEDICARE

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