NPI age
20 years
Enumerated 2006-05-18
● 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
800 E 17th St
Idaho Falls, ID 834046151
Mailing address
800 E 17th St
Idaho Falls, ID 834046151
Authorized official
Michael J Bettiga, RPH
SR. Vice President Health Services
📞 9204294297
Individual providers at this organization
5 individual providers on file at this primary practice address.
- Anna Himrich Pharmacist NPI 1114318086
- Scott Homer, O.D. Optometrist NPI 1760433684
- Carrie Lindley, PHARM D Pharmacist NPI 1194088310
- Jared Moore, PHARMD Pharmacist NPI 1245593284
- Lonnie Weathermon, PHARMD Pharmacist NPI 1639433543
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 | 1379406 | MEDICARE |
| 01 | 17836 | MEDICARE |
| 01 | 213121-5 | EYEMED |
| 01 | 014068 | VIP |
| 01 | 42505 | DAVIS VISION |
| 05 (ID) | 806430104 | |
| 05 (ID) | 000310100 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
ShopKo Optical 068
Practice context
Multi-provider organization. 5 individual providers on file at this primary address.
Provyx · Custom healthcare lists
Need all 74 Eyewear Supplier providers in Idaho?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.
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.