SHOPKO STORES OPERATING CO. LLC (NPI# 1033161419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033161419 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 113 |
| Practice Address |
5500 Martin Way E Lacey WA 98516-6326 |
| Practice Telephone | 3604564532 |
| Mailing Telephone | 3604564532 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2009-06-05 |
| 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 | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| 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 | G8855125 | 01 | |
| EYEMED | CP2230-57 | 01 | |
| MEDICARE | 17676 | 01 | |
| VIP | 014113 | 01 | |
| WA | 2016293 | 05 | |
| WA | 2020667 | 05 | |
| WA | NORIDIAN SUBMITTER ID | WA09205 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 113 | 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 |
| 1003869678 | Shopko Stores Operating Co. LLC | Technician/Technologist | 2120 Thain Grade, Lewiston, ID 83501-4105 | 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 |
| 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 |
5500 MARTIN WAY E |
| City | LACEY |
| State | WA |
| Zip Code | 98516-6326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972879401 | Kenneth R Petersen | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2012-03-29 |
| 1720351000 | Michelle Teri Kautzmann | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2012-02-16 |
| 1336336742 | George Christian Wang | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2007-09-29 |
| 1962442392 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 5500 Martin Way E, Lacey, WA 98516-6326 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730744210 | Michael Oropeza | Behavioral Analyst | 8282 28th Court Northeast, Suite A, Lacey, WA 98516 | 2019-05-09 |
| 1902361330 | Amanda Jessica Mae Allen | Behavioral Analyst | Basics Nw LLC, 8282 28th Ct Ne Suite A, Lacey, WA 98516 | 2019-02-11 |
| 1619459393 | Kayla-renee Williams | Behavioral Analyst | Basics Nw LLC 8282 28th Ct Ne, Suite A, Lacey, WA 98516 | 2018-08-30 |
| 1174004303 | Julie Ann Lisowski | Massage Therapist | 3532 Cuddy Ln Ne, Lacey, WA 98516 | 2018-08-26 |
| 1740700145 | Joseph Brandon Kimmel | Denturist | 5032 Beverly Dr Ne, Olympia, WA 98516 | 2017-06-27 |
| 1649649880 | Katie Cole | Behavioral Analyst | 8282 28th Ct Ne, Suite A, Basics Nw, LLC, Lacey, WA 98516 | 2015-09-17 |
| 1306234166 | Reza Tahernia | Dentist | 8050 Freedon Lane Ne, Suite C, Lacey, WA 98516 | 2015-01-02 |
| 1770997603 | Qualified Surgical Services Pllc | Surgery | 3697 Cameron Dr Ne, Lacey, WA 98516 | 2014-06-18 |
| 1184048688 | Stephanie Renee Hjortedal | Specialist/Technologist | 8750 Tallon Lane Ne., Lacey, WA 98516 | 2014-02-05 |
| 1295169811 | Teasha Corrado | Behavioral Analyst | 8282 28th Court Ne, Suite A, Lacey, WA 98516 | 2013-08-30 |
| Find all providers in zip 98516 | ||||
| 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 |
|---|---|---|---|---|
| 1760522981 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1350 Marvin Rd Ne, Lacey Marketplace Ste #d, Lacey, WA 98516-3877 | 2007-02-07 |
| 1699712240 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 700 Sleater Kinney Rd Se, Suite B, Lacey, WA 98503-1150 | 2006-06-01 |
| 1023409380 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 1470 Marvin Rd Ne, Lacey, WA 98516-3870 | 2015-02-09 |
| 1497807408 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 665 Sleater Kinney Rd Se, Lacey, WA 98503-1007 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004477 | The Vancouver Clinic Inc Ps | Eyewear Supplier (Equipment, not the service) | 2 S 56th Pl Ste 205, Ridgefield, WA 98642-3427 | 2020-05-15 |
| 1619514825 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 11111 Ne 8th St Ste 147, Bellevue, WA 98004-4489 | 2019-12-06 |
| 1790341675 | Zachary Robert Cooper | Eyewear Supplier (Equipment, not the service) | 301 Queen Anne Ave N # 506, Seattle, WA 98109-4513 | 2019-05-15 |
| 1235795626 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1052 Springwater Ave, Wenatchee, WA 98801-1546 | 2019-05-12 |
| 1154987535 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 9326 N Division St, Spokane, WA 99218-1227 | 2019-05-11 |
| 1699331074 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2529 Main St Ste P6-a, Union Gap, WA 98903-1690 | 2019-05-11 |
| 1972096584 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 15319 E Indiana Ave Ste 2, Spokane Valley, WA 99216 | 2018-06-08 |
| 1437648508 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 4502 S Steele St Ste 700, Tacoma, WA 98409-7224 | 2018-05-04 |
| 1407359151 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 9801 204th Ave E, Bonney Lake, WA 98391 | 2018-03-08 |
| 1457860702 | Visionpros Usa Inc | Eyewear Supplier (Equipment, not the service) | 1750 Grant Ave, Blaine, WA 98230-5155 | 2017-09-28 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO. LLC.
| 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.