Shopko Stores Operating Co LLC
Shopko Stores Operating Co LLC is a healthcare organization registered as Eyewear Supplier in Salem, OR, holding Type 2 (organization) NPI 1790736023 since 2006. The authorized official on file is Michael Bettiga, Sr. Vice President Health Services.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1790736023 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Shopko Stores Operating Co LLC |
| Other name | <Unavail> |
| Practice address | 1230 LANCASTER DR SE, Salem, OR, 97317 |
| Phone | 5033716575 |
| Enumeration date | 2006-05-12 |
| Last updated in NPPES | 2008-11-20 |
Authorized official
| Name | Michael Bettiga |
|---|---|
| Title | Sr. Vice President Health Services |
| Phone | 9204294297 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 332H00000X | Eyewear Supplier | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 039904 | Medicaid | OR | — |
| 039912 | Medicaid | OR | — |
| CP2230-36 | Other | — | EYEMED |
| 410985054-4111 | Other | — | NVA |
| 35512 | Other | — | AVESIS |
| 014111 | Other | — | VIP |
| 42514 | Other | — | DAVIS VISION |
Copy-ready billing details
Provider: Shopko Stores Operating Co LLC NPI: 1790736023 Taxonomy: 332H00000X (Eyewear Supplier) Address: 1230 LANCASTER DR SE, Salem, OR, 97317
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1639121155 | Shopko Stores Operating Co LLC | Organization | Community/Retail Pharmacy | Salem, OR |
| 1689947046 | Sylvia Fisher | Individual | Pharmacist | Salem, OR |
| 1306110143 | Leslie Eddleman | Individual | Pharmacist | Salem, OR |
| 1679029326 | Adam Nguyen | Individual | Pharmacist | Salem, OR |
| 1669950325 | Julie Le | Individual | Pharmacist | Salem, OR |
Verify this record
Cross-check NPI 1790736023 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
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Where is Shopko Stores Operating Co LLC located?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2008-11-20.