Shopko Optical 104
LBN: Shopko Stores Operating Co. Llc
Shopko Optical 104 is an health care organization with primary practice located at 747 S Main St , Brigham City UT 84302-3359. 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 (435) 723-1800, or through Bettiga, Michael J via phone (920) 429-4297.
Contact Information
Primary practice address
747 S Main St
Brigham City UT 84302-3359
Phone: (435) 723-1800
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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 | 1700839545 |
|---|---|
| LBN Legal business name | Shopko Stores Operating Co. Llc |
| DBA Doing business as | Shopko Optical 104 |
| 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700839545 | NPPES |
| Other | 35524 | AVESIS | |
| Other | 17927 | AVESIS | |
| MEDICAID | 410985054-165 | AVESIS | |
| Other | CP2230-41 | AVESIS | |
| Other | 014104 | AVESIS | |
| Other | UT04883 | AVESIS |
Popular Providers
-
Shopko Stores Operating Co. Llc
4850 W 3500 S , West Valley City UT 84120-2927 -
Pearle Vision Inc
3601 Constitution Blvd Valley Fair Mall, West Valley City UT 84119-3746 -
Vision Experts Inc
990 Medical Dr , Brigham City UT 84302-4713 -
Luxottica Of America Inc
6699 N Landmark Dr Ste A110 , Park City UT 84098-4511 -
Luxottica Retail North America Inc
754 So State St , Salt Lake City UT 84111-3822 -
National Vision, Inc.
6079 South State Street , Salt Lake City UT 84107 -
Dr. Loy Brown, Optometrist, Inc.
51 E 400 N Ste. 4 A, Cedar City UT 84721-6186 -
Shopko Stores Operating Co. Llc
5800 S Redwood Rd , Salt Lake City UT 84123-5327