Shopko Optical 107 in Bountiful, UT - Eyewear Supplier

Shopko Optical 107 is a Eyewear Supplier based in Bountiful, Utah. Shopko Optical 107 is licensed to practice in * (Not Available) (license number ) and their current practice location is 190 S 500 W, Bountiful, Utah. It can be reached at their office (for appointments etc.) via phone at (801) 295-9200.

NPI number for Shopko Optical 107 is 1205889078 and their current mailing address is 190 S 500 W, Bountiful, Utah. Shopko Optical 107 does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1205889078.

Contact Information

	Shopko Optical 107
	190 S 500 W, Bountiful, UT 84010-8729
	(801) 295-9200
	Not Available

Healthcare Provider's Profile

Full Name	Shopko Optical 107
Type	Facility
Speciality	Eyewear Supplier
Location	190 S 500 W, Bountiful, Utah
Accepts Medicare Assignments	Does not participate in Medicare Program. The facility may not accept medicare assignment.

NPI Data:

NPI Number: 1205889078
Provider Enumeration Date: 05/19/2006
Last Update Date: 07/10/2008

Medical Identifiers

Medical identifiers for Shopko Optical 107 such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1205889078	NPI	-	NPPES
17929	Other		MEDICARE
014107	Other		VIP
UT04877	Other	UT	NORIDIAN SUBMITTER ID
CP2230-53	Other		EYEMED
42591	Other		DAVIS
35537	Other		AVESIS
410985054-229	Medicaid	UT

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 107 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 107 190 S 500 W, Bountiful, UT 84010-8729 Ph: (801) 295-9200	Shopko Optical 107 190 S 500 W, Bountiful, UT 84010-8729 Ph: (801) 295-9200

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Shopko Optical 107 - in Bountiful, UT