SHOPKO STORES OPERATING CO. LLC (NPI# 1003869678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003869678 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 072 |
| Practice Address |
2120 Thain Grade Lewiston ID 83501-4105 |
| Practice Telephone | 2087461050 |
| Mailing Telephone | 2087461050 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-08-03 |
| Authorized Official Name | MICHAEL J BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
| Authorized Official Telephone | 9204294297 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE | 1379404 | 01 | |
| EYEMED | 213121-6 | 01 | |
| ID | 000310200 | 05 | |
| ID | 806430106 | 05 | |
| VIP | 014072 | 01 | |
| AVESIS | 35447 | 01 | |
| MEDICARE | 17838 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 072 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952356644 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-05-23 |
| 1124071568 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 500 N Hwy 281, Aberdeen, SD 57401-1821 | 2006-05-18 |
| 1760435333 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 3030 Wabash Ave, Springfield, IL 62704-6413 | 2006-05-18 |
| 1679526263 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1640 Appleton Rd, Menasha, WI 54952-1106 | 2006-05-18 |
| 1457304024 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1001 Highway 15 S, Fairmont, MN 56031-4456 | 2006-05-18 |
| 1497708085 | Shopko Stores Operating Co. LLC | Technician/Technologist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2006-05-18 |
| 1902859515 | Shopko Stores Operating Co. LLC | Technician/Technologist | 301 Northwest Byp, Great Falls, MT 59404-4125 | 2006-05-18 |
| 1750334348 | Shopko Stores Operating Co. LLC | Technician/Technologist | 3101 N Montana Ave, Helena, MT 59602-7813 | 2006-05-18 |
| 1083667638 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 5300 52nd St, Kenosha, WI 53144-2310 | 2006-05-17 |
| 1396797411 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 822 Park Ave, Beaver Dam, WI 53916-2266 | 2006-05-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SHOPKO STORES OPERATING CO., LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Colorado Business Entities | ShopKo Stores Operating Co., LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Iowa Business Entities | SHOPKO STORES OPERATING CO., LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Washington State Corporations | SHOPKO STORES OPERATING CO., LLC | 700 Pilgrim Way, Green Bay, WI 54304-5263 |
| Street Address |
2120 THAIN GRADE |
| City | LEWISTON |
| State | ID |
| Zip Code | 83501-4105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679903660 | Margeret Roy | Pharmacist | 2120 Thain Grade, Lewiston, ID 83501-4105 | 2013-11-12 |
| 1669728010 | Neely R Davis | Pharmacist | 2120 Thain Grade, Lewiston, ID 83501-4105 | 2012-08-02 |
| 1134151293 | Daniel Nile Evans | Optometrist | 2120 Thain Grade, Lewiston, ID 83501-4105 | 2006-07-07 |
| 1144275884 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2120 Thain Grade, Lewiston, ID 83501-4105 | 2006-05-23 |
| 1932154341 | Brenda Lynn Offerdahl | Optometrist | 2120 Thain Grade, Lewiston, ID 83501-4105 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679193759 | Jacqueline M Aldrich | Behavior Technician | 3407 12th Street C, 3407 12th Street C, Lewiston, ID 83501 | 2020-04-20 |
| 1295228054 | Provident Foundation - Wedgewood Terrace LLC | Alzheimer Center (Dementia Center) | 2114 Vineyard Avenue, Lewiston, ID 83501 | 2018-06-07 |
| 1164945325 | Xiaofei Liu | Massage Therapist | 234 Thain Rd, Lewiston, ID 83501 | 2017-07-19 |
| 1467909879 | Sharon Thulon | Registered Nurse | 1118 F Street, Lewiston, ID 83501 | 2016-09-01 |
| 1821459496 | Gem State Endoscopy | Clinic/Center | 3709 14th Street, Lewiston, ID 83501 | 2016-03-10 |
| 1508264995 | Gary L. Grogan | Psychologist | 633 Main Street, B#1, Lewiston, ID 83501 | 2014-12-17 |
| 1003189366 | John Joseph Johnson | Dentist | 3510 12th Street, Suite #600, Lewiston, ID 83501 | 2012-02-17 |
| 1306134077 | Rowena Kathryn Jackson | Counselor | 531 Bryden Avenue, Lewiston, ID 83501 | 2011-07-15 |
| 1912290388 | Staci Leanne Truby | Massage Therapist | 717 'd' Street, Lewiston, ID 83501 | 2011-05-18 |
| 1093040685 | Sharie Ann Uhlorn | Registered Nurse | 1837 Alder Court, Lewiston, ID 83501 | 2009-10-15 |
| Find all providers in zip 83501 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972169357 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2331 Thain Grade Ste 101, Lewiston, ID 83501-4119 | 2019-05-11 |
| 1861583932 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1916 19th Ave, Lewiston Ctr Mall, Lewiston, ID 83501-4069 | 2006-09-27 |
| 1629249842 | Roger L. Bergeron, O.d.p.a. | Eyewear Supplier (Equipment, not the service) | 585 Main St, Lewiston, ME 04240-5945 | 2008-03-15 |
| 1891846903 | Lewiston Optical L.L.C. | Eyewear Supplier (Equipment, not the service) | 1313 G St, Lewiston, ID 83501-1934 | 2007-01-15 |
| 1619046240 | Wolf Eye Associates, P.a. | Eyewear Supplier (Equipment, not the service) | 249 Main St, Lewiston, ME 04240-7053 | 2006-11-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063078442 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 212 W Ironwood Dr Ste B&c, Coeur D Alene, ID 83814-1403 | 2019-05-11 |
| 1972096469 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 4013 Yellowstone Ave Ste D&e, Chubbuck, ID 83202-1932 | 2018-06-11 |
| 1023528320 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1605 Blue Lakes Blvd N # A, Twin Falls, ID 83301-3322 | 2017-10-02 |
| 1255757738 | Peabody Optical | Eyewear Supplier (Equipment, not the service) | 409 S 8th St Ste 101, Boise, ID 83702-7136 | 2014-03-08 |
| 1114268257 | Eyemart Express Ltd | Eyewear Supplier (Equipment, not the service) | 2990 S 25th E, Idaho Falls, ID 83404-6515 | 2013-03-14 |
| 1720212632 | Walmart Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 1551 Washington St. N, Twin Falls, ID 83301 | 2009-05-06 |
| 1275715757 | Panhandle Eye Clinics Chartered | Eyewear Supplier (Equipment, not the service) | 704 W College Ave, St Maries, ID 83861-1824 | 2007-11-27 |
| 1447439674 | The Frame Joint | Eyewear Supplier (Equipment, not the service) | 7905 W Ustick Rd, Suite E, Boise, ID 83704-5001 | 2007-10-24 |
| 1255452843 | Optical Illusions Inc | Eyewear Supplier (Equipment, not the service) | 3160 E 17th St, Suite 150, Ammon, ID 83406-6717 | 2007-04-02 |
| 1346378304 | I Care Optical LLC | Eyewear Supplier (Equipment, not the service) | 1017 12th Ave S, Nampa, ID 83651-4660 | 2007-03-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.