Shopko Optical 107

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 107 is an health care organization with primary practice located at 190 S 500 W , Bountiful UT 84010-8729. The organization recently has 3 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, 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 (801) 295-9200, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
190 S 500 W Bountiful UT 84010-8729
Phone: (801) 295-9200
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 / Optometrist 152W00000X
Eye and Vision Services Providers / Optician 156FX1800X
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X

Profile Details

NPI number 1205889078
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 107
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 19th, 2006
Last updated Jul 10th, 2008 - 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 1205889078 NPPES
Other 17929 MEDICARE
Other 014107 MEDICARE
Other UT04877 MEDICARE
Other CP2230-53 MEDICARE
Other 42591 MEDICARE
Other 35537 MEDICARE
MEDICAID 410985054-229 MEDICARE

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