Shopko Optical 095

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 095 is an health care organization with primary practice located at 2655 Broadway Ave , Boise ID 83706-4721. 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) 345-8812, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
2655 Broadway Ave Boise ID 83706-4721
Phone: (208) 345-8812
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 1477505485
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 095
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477505485 NPPES
Other 42577 DAVIS VISION
MEDICAID 000309600 DAVIS VISION
Other 213121-3 DAVIS VISION
Other 17839 DAVIS VISION
Other 410985054-4095 DAVIS VISION
Other 1379405 DAVIS VISION
MEDICAID 806430107 DAVIS VISION
Other 014095 DAVIS VISION

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