Shopko Stores Operating Co. LLC
Shopko Stores Operating Co. LLC is a healthcare organization registered as Eyewear Supplier in Bountiful, UT, holding Type 2 (organization) NPI 1205889078 since 2006. The authorized official on file is Michael Bettiga, Sr. Vice President Health Services.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1205889078 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Shopko Stores Operating Co. LLC |
| Other name | <Unavail> |
| Practice address | 190 S 500 W, Bountiful, UT, 84010 |
| Phone | 8012959200 |
| Enumeration date | 2006-05-19 |
| Last updated in NPPES | 2008-07-10 |
Authorized official
| Name | Michael Bettiga |
|---|---|
| Title | Sr. Vice President Health Services |
| Phone | 9204294297 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 152W00000X | Optometrist | Secondary | — | — |
| 156FX1800X | Optician | Secondary | — | — |
| 332H00000X | Eyewear Supplier | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17929 | Other | — | MEDICARE |
| 014107 | Other | — | VIP |
| UT04877 | Other | UT | NORIDIAN SUBMITTER ID |
| CP2230-53 | Other | — | EYEMED |
| 42591 | Other | — | DAVIS |
| 35537 | Other | — | AVESIS |
| 410985054-229 | Medicaid | UT | — |
Copy-ready billing details
Provider: Shopko Stores Operating Co. LLC NPI: 1205889078 Taxonomy: 332H00000X (Eyewear Supplier) Address: 190 S 500 W, Bountiful, UT, 84010
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1144271123 | Shopko Stores Operating Co LLC | Organization | Community/Retail Pharmacy | Bountiful, UT |
| 1437199544 | Shawn Murray | Individual | Optometrist | Bountiful, UT |
| 1972625242 | Gary Hale | Individual | Pharmacist | Bountiful, UT |
Verify this record
Cross-check NPI 1205889078 against the authoritative CMS record: view Shopko Stores Operating Co. LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Shopko Stores Operating Co. LLC?
Who is the authorized official for Shopko Stores Operating Co. LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2008-07-10.