SHOPKO STORES OPERATING CO. LLC (NPI# 1073565123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073565123 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 070 |
| Practice Address |
13414 E Sprague Ave Spokane Valley WA 99216-0848 |
| Practice Telephone | 5099242015 |
| Mailing Telephone | 5099242015 |
| Enumeration Date | 2006-05-17 |
| 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 |
|---|---|---|---|
| VIP | 014070 | 01 | |
| EYEMED | 213121-29 | 01 | |
| WA | NORIDIAN SUBMITTER ID | WA09206 | 01 |
| MEDICARE | 10829 | 01 | |
| WA | 2013142 | 05 | |
| WA | 2005056 | 05 | |
| AVESIS | 35546 | 01 | |
| MEDICARE | G8854794 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 070 | 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 |
13414 E SPRAGUE AVE |
| City | SPOKANE VALLEY |
| State | WA |
| Zip Code | 99216-0848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568735355 | Joseph E Samek | Pharmacist | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2012-02-09 |
| 1619249422 | Megan Baldwin | Pharmacist | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2012-02-08 |
| 1306118195 | Jeff Simpson | Pharmacist | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2012-02-08 |
| 1336474410 | Kristopher Sherrill | Optometrist | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2009-10-07 |
| 1205063104 | Rebecca Jael Jangula | Optometrist | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2009-06-18 |
| 1417996976 | Marielle Kwon | Optometrist | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2006-06-06 |
| 1144269184 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 13414 E Sprague Ave, Spokane Valley, WA 99216-0848 | 2006-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053920124 | Aark Laboratory | Clinical Medical Laboratory | 12709 E Mirabeau Pkwy Bldg A Ste 500, Spokane, WA 99216 | 2020-07-24 |
| 1922622158 | Vera Whole Health Wa, PC | Clinic/Center | 16009 E Indiana Ave, Spokane Valley, WA 99216 | 2020-06-03 |
| 1023654001 | Rebecca Elizabeth Ryan | Massage Therapist | 12505 E 23rd Ave, Spokane Valley, WA 99216 | 2019-11-25 |
| 1356992903 | Creative Communication LLC | Speech-Language Pathologist | 13607 E. Sprague Ave, Spokane Valley, WA 99216 | 2019-09-25 |
| 1972096584 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 15319 E Indiana Ave Ste 2, Spokane Valley, WA 99216 | 2018-06-08 |
| 1356845655 | Rp Operations, LLC | Assisted Living Facility | 13013 E Mission Ave, Spokane Valley, WA 99216 | 2018-03-21 |
| 1174036305 | Talk, Learn and Communicate | Speech-Language Pathologist | 13607 East Spraque Avenue, Spokane Valley, WA 99216 | 2017-11-09 |
| 1134638281 | Vtc Vitality Healthcare | Pain Medicine | 12409 E Mission Ave Ste 102, Spokane Valley, WA 99216 | 2017-09-20 |
| 1285150086 | Robert C Tsay Jr. | Pharmacist | 12415 E 12th Ave, Apt 110, Spokane Valley, WA 99216 | 2017-08-15 |
| 1629505607 | Spokane Valley Medical, Inc | Durable Medical Equipment & Medical Supplies | 12509 E. Mission Ave, Suite #103, Spokane, WA 99216 | 2017-05-22 |
| Find all providers in zip 99216 | ||||
| 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 |
|---|---|---|---|---|
| 1972096584 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 15319 E Indiana Ave Ste 2, Spokane Valley, WA 99216 | 2018-06-08 |
| 1770858789 | Encore Vision, Inc | Eyewear Supplier (Equipment, not the service) | 15735 E Broadway Ave Ste 3c2, Spokane Valley, WA 99037-8547 | 2012-03-09 |
| 1245321926 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 14720 E Indiana St, Spokane Valley Mall, Spokane Valley, WA 99216-1814 | 2006-09-27 |
| 1831280031 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 14700 E Indiana Ave Spc 1008, Spokane Valley, WA 99216 | 2006-09-27 |
| 1104217462 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 5601 E Sprague Ave, Spokane Valley, WA 99212-0826 | 2015-02-09 |
| 1306194394 | Robert Maher Md Robert Davis Md Et Al | Eyewear Supplier (Equipment, not the service) | 12525 E Mission Ave, Spokane Valley, WA 99216-1063 | 2012-08-22 |
| 1972851020 | Spokane Optical Company LLC | Eyewear Supplier (Equipment, not the service) | 16201 E Indiana Ave, 5000, Spokane Valley, WA 99216-2830 | 2012-08-21 |
| 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 |
| 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 |
| 1982121075 | Jand Inc. | Eyewear Supplier (Equipment, not the service) | 3501 Fremont Ave N, Seattle, WA 98103-8813 | 2017-08-29 |
| Find all providers with the same taxonomy | ||||
| City | SPOKANE VALLEY |
| Zip Code | 99216 |
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.