NPI age
20 years
Enumerated 2006-05-17
● Active Type 2 · Organization
Shopko Stores Operating Co. Llc
Shopko Stores Operating Co. Llc is 1 of 74 eyewear supplier organizations in Idaho.
Primary specialty
Eyewear Supplier
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Bettiga
SR. Vice President Health Services
Last NPPES update
2009-08-03
Source: monthly bulk 2026-05
How this organization compares
Across 74 active eyewear supplier providers in Idaho.
NPI age
20 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
1
In the 43% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-05Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
4215 Yellowstone Ave
Chubbuck, ID 832022419
Mailing address
4215 Yellowstone Ave
Chubbuck, ID 832022419
Authorized official
Michael J Bettiga, RPH
SR. Vice President Health Services
📞 9204294297
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Kirsten Blair, RPH Pharmacist NPI 1912424375
- Melissa Herzog, PHARMD Pharmacist NPI 1396000121
- Stephen Schiers, RPH Pharmacist NPI 1033460647
- Aime Taylor, PHARMD Pharmacist NPI 1225391436
Specialties
-
Eyewear Supplier PrimaryAn organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
-
Technician/TechnologistOpticians help fit eyeglasses and contact lenses, following prescriptions from Ophthalmologists and Optometrists. They also help customers decide which eyeglass frame or contact lenses to buy.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | 17712 | MEDICARE |
| 01 | CP2230-10 | EYEMED |
| 05 (ID) | 000309500 | |
| 01 | 42499 | DAVIS VISION |
| 05 (ID) | 806430100 | |
| 01 | 014063 | VIP |
| 01 | 1593901 | MEDICARE |
| 05 (ID) | 805180700 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
ShopKo Optical 063
Practice context
Multi-provider organization. 4 individual providers on file at this primary address.
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Request a quote →How to verify this organization
- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.