SHOPKO STORES OPERATING CO. LLC (NPI# 1063465789) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063465789 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 061 |
| Practice Address |
501 Highway 10 Se Saint Cloud MN 56304-1250 |
| Practice Telephone | 3202534695 |
| Mailing Telephone | 3202534695 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-04-15 |
| 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 |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VIP | 014061 | 01 | |
| AVESIS | 35480 | 01 | |
| MN MA FIRST PLAN OF MN | 55306HA | 01 | |
| MEDICARE | 17832 | 01 | |
| MN HEALTH PARTNERS | 21527 | 01 | |
| NATIONAL VISION ADMIN. | 410985054-4061 | 01 | |
| MN MA FIRST PLAN OF MN | 26887SH | 01 | |
| MN MA MEDICA CHOICE CARE | 2100301 | 01 | |
| EYEMED | 213121-17 | 01 | |
| DAVIS | 42497 | 01 | |
| MN MA PRIMEWEST HEALTH | 20019120524 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 061 | 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 |
501 HIGHWAY 10 SE |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56304-1250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114971926 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 501 Highway 10 Se, Saint Cloud, MN 56304-1250 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316597701 | Liza Aberle | Naturopath | 22 Wilson Ave Ne # 205, Saint Cloud, MN 56304 | 2019-09-17 |
| 1902386089 | Jd Home Health Care | Clinic/Center | 4896 52nd St, St. Cloud, MN 56304 | 2018-08-17 |
| 1861490690 | Julia Anna Blonigen | Speech-Language Pathologist | 1882 Kilian Blvd, St Cloud, MN 56304 | 2005-07-14 |
| 1700111705 | St. Cloud Metropolitan Transit Commission | Non-emergency Medical Transport (VAN) | 665 Franklin Ave Ne, Saint Cloud, MN 56304-0225 | 2009-10-08 |
| 1053364976 | In Home Health LLC | Home Health | 605 Franklin Ave Ne, Saint Cloud, MN 56304-0225 | 2006-05-19 |
| 1376946806 | Charity Anne Hans | Social Worker | 511 3rd St Ne, Saint Cloud, MN 56304-0311 | 2014-09-29 |
| 1568082428 | Cloud Home Health Care Services LLC | Clinic/Center | 22 Wilson Ave Ne Ste 208, Saint Cloud, MN 56304-0440 | 2020-04-21 |
| 1326688417 | Sunshine Care Services Inc | In Home Supportive Care | 22 Wilson Ave Ne Ste 15, Saint Cloud, MN 56304-0440 | 2020-01-07 |
| 1295039204 | Rose Melinda Stark-rose | Psychologist | 22 Wilson Ave Ne # 110, Saint Cloud, MN 56304-0440 | 2011-01-05 |
| 1750448478 | Robin Stacey Colburn | Advanced Practice Midwife | 22 Wilson Ave Ne Ste 205, Saint Cloud, MN 56304-0440 | 2007-01-02 |
| Find all providers in zip 56304 | ||||
| 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 |
|---|---|---|---|---|
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1043721202 | Eye Doctors Optical Outlets, Pa | Eyewear Supplier (Equipment, not the service) | 140 E 13th St, Saint Cloud, FL 34769-4703 | 2017-10-16 |
| 1942408521 | Essilor Laboratories of America, Inc | Eyewear Supplier (Equipment, not the service) | 6650 Saukview Dr, Saint Cloud, MN 56303-0806 | 2007-07-05 |
| 1134327794 | Essilor Laboratories of America, Inc | Eyewear Supplier (Equipment, not the service) | 6925 Saukview Dr, Saint Cloud, MN 56303-0813 | 2007-07-05 |
| 1407051279 | Eye Kraft Optical, Inc | Eyewear Supplier (Equipment, not the service) | 8 Mcleland Rd, Saint Cloud, MN 56303-2049 | 2007-06-20 |
| 1659498210 | Wimmer Opticians Inc | Eyewear Supplier (Equipment, not the service) | 901 W Saint Germain St, Saint Cloud, MN 56301-3460 | 2007-03-26 |
| 1376635466 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 4165 W Division St, Ste C7, Saint Cloud, MN 56301-3740 | 2006-09-28 |
| 1912928839 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 4101 W Division St Ste 20, Saint Cloud, MN 56301-5015 | 2006-07-23 |
| 1740212331 | America's Best Contacts and Eyeglasses, Inc. | Eyewear Supplier (Equipment, not the service) | 4142 W Division St, Saint Cloud, MN 56301-3706 | 2006-07-06 |
| 1174575500 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2006-05-16 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56304 |
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.