Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 068
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
800 E 17TH ST, IDAHO FALLS, ID 83404-6151
(208) 522-3795
Mailing address
800 E 17TH ST, IDAHO FALLS, ID 83404-6151
(208) 522-3795
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000310100
—
ID
01
—
014068
VIP
—
01
—
1379406
MEDICARE
—
01
—
17836
MEDICARE
—
01
—
213121-5
EYEMED
—
01
—
42505
DAVIS VISION
—
05
—
806430104
—
ID
Enumeration date
05/18/2006
Last updated
08/03/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us