ShopKo Optical 104 – Eyewear Supplier, NPI 1700839545

ShopKo Optical 104 is a healthcare provider. based in Brigham city, Utah. specializing in Eyewear Supplier. The NPI Number for ShopKo Optical 104 is 1700839545

Main info

Organization
Name
ShopKo Optical 104
NPI
1700839545
Phone
(435) 723-1800
Address
747 S MAIN ST
Authorized Official
MICHAEL J BETTIGA SR. VICE PRESIDENT HEALTH SERVICES RPH
Enumeration Date
19 May 2006
Last Update Date
10 July 2008
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience55
Completeness80
Years active:20State licenses:0Digital endpointsUpdated within 12 months

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Provider Addresses for ShopKo Optical 104

  • 747, South Main Street, Brigham City, Box Elder County, Utah, 84302, United States

    BRIGHAM CITY, UT 843023359

    Phone: (435) 723-1800

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84302)

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Reviews

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Frequently asked questions

Where can patients find ShopKo Optical 104's NPI?
You can confirm ShopKo Optical 104 with NPI 1700839545; it appears in the national provider directory.
Is ShopKo Optical 104's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is ShopKo Optical 104?
The page reflects Eyewear Supplier for ShopKo Optical 104. Clinical services aligned with this taxonomy classification.
Does ShopKo Optical 104 practice in Utah?
You will see Brigham City, Utah on file for ShopKo Optical 104 alongside any extra practice locations.
Is ShopKo Optical 104 a real provider?
This page reflects official NPPES data for NPI 1700839545. Always confirm identity and privileges with the practice and licensing boards.

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