Shopko Optical 072
LBN: Shopko Stores Operating Co. Llc
Shopko Optical 072 is an health care organization with primary practice located at 2120 Thain Grade , Lewiston ID 83501-4105. 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) 746-1050, or through Bettiga, Michael J via phone (920) 429-4297.
Contact Information
Primary practice address
2120 Thain Grade
Lewiston ID 83501-4105
Phone: (208) 746-1050
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optician | 156FX1800X | ||
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X |
Profile Details
| NPI number | 1003869678 |
|---|---|
| LBN Legal business name | Shopko Stores Operating Co. Llc |
| DBA Doing business as | Shopko Optical 072 |
| Authorized official | Bettiga, Michael J RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 18th, 2006 |
| Last updated | Aug 3rd, 2009 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003869678 | NPPES |
| Other | 1379404 | MEDICARE | |
| MEDICAID | 000310200 | MEDICARE | |
| Other | 014072 | MEDICARE | |
| Other | 17838 | MEDICARE | |
| Other | 213121-6 | MEDICARE | |
| MEDICAID | 806430106 | MEDICARE | |
| Other | 35447 | MEDICARE |
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