SHOPKO STORES OPERATING CO. LLC (NPI# 1164474698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164474698 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 038 |
| Practice Address |
2208 N Webb Rd Grand Island NE 68803-1739 |
| Practice Telephone | 3083827661 |
| Mailing Telephone | 3083827661 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-02-11 |
| Authorized Official Name | MR. 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 |
|---|---|---|---|
| EYEMED | 213121-23 | 01 | |
| MEDICARE | 17882 | 01 | |
| NE | 10025074000 | 05 | |
| DAVIS | 35858 | 01 | |
| VIP | 014038 | 01 | |
| MEDICARE | 099548 | 01 | |
| AVESIS | 35496 | 01 | |
| BLOCK | 914651 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 038 | 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 |
2208 N WEBB RD |
| City | GRAND ISLAND |
| State | NE |
| Zip Code | 68803-1739 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366493835 | William R Zeigler | Optometrist | 2208 N Webb Rd, Grand Island, NE 68803-1739 | 2006-05-12 |
| 1619903440 | James H Demler | Optometrist | 2208 N Webb Rd, Grand Island, NE 68803-1739 | 2006-06-23 |
| 1770535338 | William Meade Glassbrenner | Optometrist | 2208 N Webb Rd, Grand Island, NE 68803-1739 | 2006-05-16 |
| 1790736072 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2208 N Webb Rd, Grand Island, NE 68803-1739 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053884 | Christopher Patrin | Counselor | 1811 West 2nd Street, Suite 450, Grand Island, NE 68803 | 2020-11-03 |
| 1942848593 | Specialized Outpatient Services | Counselor | 1811 West 2nd Street Suite 450, Grand Island, NE 68803 | 2019-12-13 |
| 1558910604 | Grand Island Regional Medical Center | General Acute Care Hospital | 3533 Prairieview Street, Grand Island, NE 68803 | 2019-09-10 |
| 1992225817 | Destiny Mostek | Dietitian, Registered | 2201 N. Broadwell Ave, Grand Island, NE 68803 | 2017-06-21 |
| 1184150591 | Brandy Rae Bird | Registered Nurse | Mosaic Msu 2905 West 5th Street, Grand Island, NE 68803 | 2017-05-04 |
| 1831633171 | Karla Jean Sextro | Counselor | 2112 W. Faidley Ave, Grand Island, NE 68803 | 2016-12-06 |
| 1689062895 | Good Hands Clinic PC | Specialist | 524 South Webb Rd, Suite 1, Grand Island, NE 68803 | 2014-12-23 |
| 1346664554 | Lindsey M Modlin | Dental Hygienist | 4234 New York Ave, Grandi Island, NE 68803 | 2014-02-07 |
| 1568711711 | Danessa Marie Kenney | Counselor | 908 N. Howard Ave. Suite 107, Nebraska Children's Home Society, Grand Island, NE 68803 | 2012-09-04 |
| 1649528563 | Nicole Morris | Physical Therapist | 2116 Faidley Ave, Grand Island, NE 68803 | 2012-08-27 |
| Find all providers in zip 68803 | ||||
| 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 |
|---|---|---|---|---|
| 1952967325 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1919 N Diers Ave Ste B, Grand Island, NE 68803-1284 | 2019-05-11 |
| 1649325143 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 3404 W 13th St, Conestoga Mall Ste #105, Grand Island, NE 68803-2389 | 2007-01-24 |
| 1891821039 | Vision Associates Inc | Eyewear Supplier (Equipment, not the service) | 1437 N Webb Rd, Grand Island, NE 68803-2313 | 2007-02-24 |
| 1124085618 | Family Eyecare Center, PC | Eyewear Supplier (Equipment, not the service) | 401 N Eddy St, Grand Island, NE 68801-4558 | 2006-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003462763 | Thundercloud Optical, LLC | Eyewear Supplier (Equipment, not the service) | 8838 Washington Cir, Omaha, NE 68127-4011 | 2019-08-16 |
| 1841856234 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2801 Pine Lake Rd Ste J, Lincoln, NE 68516-6041 | 2019-05-12 |
| 1659937027 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2802 S 143rd Plz, Omaha, NE 68144-5611 | 2019-05-11 |
| 1902462377 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1130 S 13th St Ste 200, Norfolk, NE 68701-5733 | 2019-05-11 |
| 1760048136 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 848 Cornhusker Rd Ste 105, Bellevue, NE 68123-4433 | 2019-05-11 |
| 1578099024 | Walman Optical Company | Eyewear Supplier (Equipment, not the service) | 12240 Emmet St, Omaha, NE 68164-4265 | 2017-05-03 |
| 1679921720 | Statton Optical | Eyewear Supplier (Equipment, not the service) | 4645 Normal Blvd Ste 132, Lincoln, NE 68506-5823 | 2016-05-31 |
| 1477890937 | Arkfeld, Parson, Goldstein, PC | Eyewear Supplier (Equipment, not the service) | 450 Regency Pkwy, Suite 110, Omaha, NE 68114-3764 | 2013-01-03 |
| 1588950869 | Sutton Vision Center Inc | Eyewear Supplier (Equipment, not the service) | 103 N Saunders Ave, Sutton, NE 68979-2506 | 2011-06-24 |
| 1144530213 | Gothenburg-cozad Vision Clinic,p.c. | Eyewear Supplier (Equipment, not the service) | 916 Avenue F, Gothenburg, NE 69138-2060 | 2010-10-07 |
| Find all providers with the same taxonomy | ||||
| City | GRAND ISLAND |
| Zip Code | 68803 |
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.