SHOPKO STORES OPERATING CO. LLC (NPI# 1083667406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083667406 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 141 |
| Practice Address |
313 N Roosevelt Ave Burlington IA 52601-1757 |
| Practice Telephone | 3197589145 |
| Mailing Telephone | 3197589145 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-01-30 |
| 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 | 014141 | 01 | |
| MEDICARE | 17698 | 01 | |
| MEDICARE | I3516 | 01 | |
| AVESIS | 35436 | 01 | |
| EYEMED | CP2521-1 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 141 | 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 |
313 N ROOSEVELT AVE |
| City | BURLINGTON |
| State | IA |
| Zip Code | 52601-1757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215988183 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 313 N Roosevelt Ave, Burlington, IA 52601-1757 | 2006-05-15 |
| 1417399890 | Benjamin Tatsunori Iwai | Optometrist | 313 N Roosevelt Ave, Burlington, IA 52601-1757 | 2013-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033748017 | Quentin Eugene Hill | Technician | 528 South 7th St, Burlington, IA 52601 | 2020-04-02 |
| 1619320645 | Alisa Nicole Smith | Social Worker | 409 N. 4th St., Burlington, IA 52601 | 2016-07-14 |
| 1568870020 | Denise Reichman | Registered Nurse | 2509 Sunrise Ln, Burlington, IA 52601 | 2014-07-29 |
| 1891131355 | Ainsley Joyce Fedler | Speech-Language Pathologist | 9302 Glenmark Drive, Burlington, IA 52601 | 2013-05-10 |
| 1851640932 | Melissa A Rupp | Optometrist | 1035 Lawrence Drive, Suite 106, Burlington, IA 52601 | 2012-09-05 |
| 1508123068 | Advanced Home Health Care | Home Health | 550 S. Roosevelt, Burlington, IA 52601 | 2012-04-20 |
| 1144591926 | David Eric Johnson | Pharmacist | 201 South Central, Burlington, IA 52601 | 2012-01-25 |
| 1548537525 | Michael James Colgan | Pharmacist | 3245 Agency Street, Burlington, IA 52601 | 2011-11-19 |
| 1881971190 | Elaine Frances Lehman | Counselor | 724 North 3rd St., Burlington, IA 52601 | 2011-11-15 |
| 1992086508 | Jacqueline Gwen Robbins | Counselor | 4715 Sullivan Slough Road, Burlington, IA 52601 | 2011-09-09 |
| Find all providers in zip 52601 | ||||
| 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 |
|---|---|---|---|---|
| 1982202966 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 1433 Boone Station Dr, Burlington, NC 27215-8229 | 2020-10-13 |
| 1053861005 | Hw Holdings | Eyewear Supplier (Equipment, not the service) | 1035 Lawrence St Ste 106, Burlington, IA 52601-1549 | 2016-10-13 |
| 1770030710 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 1300 Middlesex Turnpike, Burlington, MA 01803 | 2016-09-07 |
| 1639444326 | Keith B. Nice, O.d. | Eyewear Supplier (Equipment, not the service) | 944 S Church St, Burlington, NC 27215-3846 | 2012-03-14 |
| 1043493760 | Jones & Williams Optometrists PC | Eyewear Supplier (Equipment, not the service) | 498 15th St, Burlington, CO 80807-1624 | 2007-12-17 |
| 1255523411 | For Eyes Optical of Pa | Eyewear Supplier (Equipment, not the service) | 2 Wayside Rd, Unit 2g, Burlington, MA 01803 | 2007-08-13 |
| 1669662391 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 927 Boston Dr, Alamance Crossings S/c Ste #d3, Burlington, NC 27215-8232 | 2007-07-30 |
| 1609922087 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2501 Burlington Mount Holly Rd, Burlington Ctr, Burlington, NJ 08016-4802 | 2007-01-26 |
| 1609932839 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 600 Cascade Mall Dr, Cascade Mall, Burlington, WA 98233-3260 | 2006-12-30 |
| 1912063454 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2501 Mt Holly Rd, Burlington Ctr Ste #100, Burlington, NJ 08016-4802 | 2006-12-29 |
| Find all providers in BURLINGTON | ||||
| City | BURLINGTON |
| Zip Code | 52601 |
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.