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Shopko Stores Operating Co. LLC

Eyewear Supplier in Boise, ID · enumerated 2006 · authorized official Michael Bettiga, Sr. Vice President Health Services.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1477505485

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Registry record

Entity type Organization (Type 2)
Legal business name Shopko Stores Operating Co. LLC
Other name <Unavail>
Practice address 2655 Broadway Ave, Boise, ID, 83706
Phone (208) 345-8812
Enumeration date May 17, 2006
Last updated in NPPES Aug 3, 2009

Taxonomy & classification

156FX1800X Optician Eye and Vision Services Providers Secondary
332H00000X Eyewear Supplier Suppliers Primary

Authorized official

Name Michael Bettiga
Title Sr. Vice President Health Services
Phone (920) 429-4297

Other identifiers

Identifier Type State Issuer
42577 Other - DAVIS VISION
000309600 Medicaid ID -
213121-3 Other - EYEMED
17839 Other - MEDICARE
410985054-4095 Other - UWG
1379405 Other - MEDICARE
806430107 Medicaid ID -
014095 Other - VIP

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.

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Frequently asked questions

How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2009-08-03. Verify at npiregistry.cms.hhs.gov.
Where is Shopko Stores Operating Co. LLC located?
The practice location on file with NPPES is in Boise, ID.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2009-08-03.