SHOPKO STORES OPERATING CO. LLC (NPI# 1366495954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366495954 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 036 |
| Practice Address |
3708 Hwy 63 N Rochester MN 55906-3902 |
| Practice Telephone | 5072810657 |
| Mailing Telephone | 5072810657 |
| Enumeration Date | 2006-05-18 |
| 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 |
|---|---|---|---|
| EYEMED | 213121-16 | 01 | |
| MN HEALTH PARTNERS | 36056 | 01 | |
| MEDICARE | 17826 | 01 | |
| MN MA FIRST PLAN OF MN | 64031SH | 01 | |
| MN MA PRIMEWEST HEALTH | 20019120529 | 01 | |
| DAVIS | 42619 | 01 | |
| AVESIS | 35472 | 01 | |
| NATIONAL VISION ADMIN. | 411740865-4036 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 036 | 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 |
3708 HWY 63 N |
| City | ROCHESTER |
| State | MN |
| Zip Code | 55906-3902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124079942 | Andrea Marie Lloyd | Optometrist | 3708 Hwy 63 N, Rochester, MN 55906-3902 | 2006-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912472440 | Carole Ellen Jenson | Nurse Practitioner | Rochester Clinic, 3070 Wellner Drive Ne, Rochester, MN 55906 | 2018-10-11 |
| 1760853980 | Sebandy Home Care Services, LLC | Health Maintenance Organization | 2548 Lisa Ln Ne, Rochester, MN 55906 | 2015-10-14 |
| 1538550611 | Rachel Eldersveld | Nurse Practitioner | 716 12th Ave Ne, Rochester, MN 55906 | 2015-02-11 |
| 1639590045 | Riverstone Psychological Services | Community/Behavioral Health | 511 Northern Hills Dr Ne, Suite 2, Rochester, MN 55906 | 2014-01-02 |
| 1396177457 | Marjorie Evelyn Murray | Custodial Care Facility | 4501-22nd Ave N.e., Rochester, MN 55906 | 2013-07-31 |
| 1447532411 | Peter M Holm | Dentist | 120 North Broadway Ne, Suite B, Good Samaritan Dental Clinic, Rochester, MN 55906 | 2011-09-15 |
| 1154615193 | Amy Johnson Tremain | Psychologist | 3228 6th Ave Ne Unit B, Rochester, MN 55906 | 2011-06-07 |
| 1235451816 | Connie Krueger | Dental Hygienist | 120 North Broadway, Ne, Suite B, Rochester, MN 55906 | 2010-02-23 |
| 1700115508 | Smn Home Care, LLC | Home Health | 1700 N. Broadway, Suite 114, Rochester, MN 55906 | 2009-12-08 |
| 1528395068 | Ryley D Layden | Chiropractor | 3169 Wellner Dr. Ne, Suite C, Rochester, MN 55906 | 2009-11-04 |
| Find all providers in zip 55906 | ||||
| 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 |
|---|---|---|---|---|
| 1033717277 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 300 Bellwood Dr, Rochester, NY 14606-4262 | 2020-10-10 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1740633031 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 2854 41st St Nw, Suite 103, Rochester, MN 55901-7825 | 2016-07-21 |
| 1588036479 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 600 Jefferson Rd, Suite 3, Rochester, NY 14623-3230 | 2015-10-30 |
| 1396139838 | Strong Optical Shop | Eyewear Supplier (Equipment, not the service) | 1317 Mount Hope Ave, Rochester, NY 14620-3923 | 2015-03-23 |
| 1538553268 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 335 Westfall Road, Rochester, NY 14620 | 2015-03-19 |
| 1962801878 | The Association for The Blind and Visually Impaired - Goodwill Industr | Eyewear Supplier (Equipment, not the service) | 500 S Clinton Ave, Rochester, NY 14620-1198 | 2014-08-15 |
| 1316271695 | Highlander Healthcare Supply Services Inc | Eyewear Supplier (Equipment, not the service) | 847 Goodman St S, Rochester, NY 14620-2523 | 2009-09-20 |
| 1700018363 | Kls Optical Inc. | Eyewear Supplier (Equipment, not the service) | 215 Elton Hills Dr Nw, #26, Rochester, MN 55901-2482 | 2009-08-17 |
| 1891982724 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 4611 Main Ave Se, Rochester, MN 55904-5904 | 2007-09-25 |
| Find all providers in ROCHESTER | ||||
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| 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.