OrganizationActive
Shopko Stores Operating Co. LLC
NPI 1104879808 · Eyewear Supplier · Grafton, WI
Shopko Stores Operating Co. LLC is a Eyewear Supplier organization in Grafton, WI (NPI 1104879808).
Provider details
- NPI number
- 1104879808
- Entity type
- Organization
- Primary specialty
- Eyewear SupplierSuppliers
- Organization subpart
- No
- Authorized official
- Michael Bettiga, Sr. Vice President Health Services(920) 429-4297
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1771 Wisconsin Ave
Grafton, WI 53024-2437
Phone: (262) 375-0505
Street-level locationGet directions
Mailing address
1771 Wisconsin Ave
Grafton, WI 53024-2437
Other names (DBA / former)
- Doing business as
- Shopko Optical 090
Registry dates
- Enumerated
- 2006-05-17
- Last updated
- 2008-02-11
Frequently asked questions
- What is Shopko Stores Operating Co. LLC's NPI number?
- Shopko Stores Operating Co. LLC's National Provider Identifier (NPI) is 1104879808, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Shopko Stores Operating Co. LLC?
- Shopko Stores Operating Co. LLC is classified in the NPPES registry as Eyewear Supplier (Suppliers).
- Where is Shopko Stores Operating Co. LLC located?
- Shopko Stores Operating Co. LLC's practice location on file with NPPES is 1771 Wisconsin Ave, Grafton, WI 53024-2437.
- What is Shopko Stores Operating Co. LLC's phone number?
- The practice phone number listed in the NPPES registry for Shopko Stores Operating Co. LLC is (262) 375-0505.
- Who is the authorized official for Shopko Stores Operating Co. LLC?
- The authorized official listed on Shopko Stores Operating Co. LLC's NPPES record is Michael Bettiga, Sr. Vice President Health Services. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Shopko Stores Operating Co. LLC's NPI active?
- Yes — Shopko Stores Operating Co. LLC's NPI (1104879808) is active in the NPPES registry as of the last update on 2008-02-11.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.