Shopko Optical 109 is a
Eyewear Supplier based in Riverdale, Utah. Shopko Optical 109 is licensed to practice in * (Not Available) (license number ) and their current practice location is
4060 Riverdale Rd, Riverdale, Utah. It can be reached at their office (for appointments etc.) via phone at
(801) 392-4300.
NPI number for Shopko Optical 109 is 1295788065 and their current mailing address is 4060 Riverdale Rd, Riverdale, Utah. Shopko Optical 109
does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1295788065.
Healthcare Provider's Profile
| Full Name | Shopko Optical 109 |
|---|
| Type | Facility |
|---|
| Speciality | Eyewear Supplier |
|---|
| Location | 4060 Riverdale Rd, Riverdale, Utah |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1295788065
- Provider Enumeration Date: 05/19/2006
- Last Update Date: 07/10/2008
Medical Identifiers
Medical identifiers for Shopko Optical 109 such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1295788065 | NPI | - | NPPES |
| 410985054-408 | Medicaid | UT | |
| 014109 | Other | | VIP |
| UT04871 | Other | UT | NORIDIAN SUBMITTER ID |
| 42510 | Other | | DAVIS |
| 17932 | Other | | MEDICARE |
| 000090125 | Other | | MEDICARE |
| CP2230-48 | Other | | EYEMED |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 156FX1800X | Technician/technologist - Optician | (* (Not Available)) | Secondary |
| 332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shopko Optical 109 is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shopko Optical 109
4060 Riverdale Rd,
Riverdale, UT 84405-1518
Ph: (801) 392-4300 | Shopko Optical 109
4060 Riverdale Rd,
Riverdale, UT 84405-1518
Ph: (801) 392-4300 |
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