SHOPKO STORES OPERATING CO. LLC (NPI# 1497708085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497708085 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 069 |
| Practice Address |
217 W Ironwood Dr Coeur D Alene ID 83814-2651 |
| Practice Telephone | 2087658078 |
| Mailing Telephone | 2087658078 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-08-03 |
| 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 | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 000309800 | 05 | |
| ID | 806430105 | 05 | |
| EYEMED | 213121-4 | 01 | |
| MEDICARE | 1379403 | 01 | |
| VIP | 014069 | 01 | |
| AVESIS | 35444 | 01 | |
| DAVIS VISION | 42507 | 01 | |
| MEDICARE | 17837 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 069 | 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 |
| 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 |
| 1396797411 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 822 Park Ave, Beaver Dam, WI 53916-2266 | 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 |
217 W IRONWOOD DR |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814-2651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598319337 | Haley Vision Center, Pllc | Optometrist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2019-07-30 |
| 1528541042 | Tyler Joel Cress | Pharmacist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-1400 | 2018-09-11 |
| 1679966063 | Shawna Elliott | Pharmacist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2015-03-10 |
| 1750637104 | Lonnie Earle Mccurdie Jr. | Pharmacist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2012-08-02 |
| 1376808170 | Tavis John Osler | Pharmacist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2012-07-08 |
| 1417211095 | Mark Schneider | Pharmacist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2012-06-28 |
| 1164477881 | Shopko Stores Operating Co LLC | Pharmacy | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| 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 |
|---|---|---|---|---|
| 1063078442 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 212 W Ironwood Dr Ste B&c, Coeur D Alene, ID 83814-1403 | 2019-05-11 |
| 1063500296 | Visionworks, Inc | Eyewear Supplier (Equipment, not the service) | 255 W Canfield Ave, Coeur D Alene, ID 83815-7736 | 2006-10-11 |
| 1427449784 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 355 E Neider Ave, Coeur D Alene, ID 83815-3723 | 2015-02-09 |
| 1093851081 | Coeur D Alene Optical, Inc. | Eyewear Supplier (Equipment, not the service) | 1814 Lincoln Way, Coeur D Alene, ID 83814-2540 | 2007-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972169357 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2331 Thain Grade Ste 101, Lewiston, ID 83501-4119 | 2019-05-11 |
| 1972096469 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 4013 Yellowstone Ave Ste D&e, Chubbuck, ID 83202-1932 | 2018-06-11 |
| 1023528320 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1605 Blue Lakes Blvd N # A, Twin Falls, ID 83301-3322 | 2017-10-02 |
| 1255757738 | Peabody Optical | Eyewear Supplier (Equipment, not the service) | 409 S 8th St Ste 101, Boise, ID 83702-7136 | 2014-03-08 |
| 1114268257 | Eyemart Express Ltd | Eyewear Supplier (Equipment, not the service) | 2990 S 25th E, Idaho Falls, ID 83404-6515 | 2013-03-14 |
| 1720212632 | Walmart Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 1551 Washington St. N, Twin Falls, ID 83301 | 2009-05-06 |
| 1275715757 | Panhandle Eye Clinics Chartered | Eyewear Supplier (Equipment, not the service) | 704 W College Ave, St Maries, ID 83861-1824 | 2007-11-27 |
| 1447439674 | The Frame Joint | Eyewear Supplier (Equipment, not the service) | 7905 W Ustick Rd, Suite E, Boise, ID 83704-5001 | 2007-10-24 |
| 1255452843 | Optical Illusions Inc | Eyewear Supplier (Equipment, not the service) | 3160 E 17th St, Suite 150, Ammon, ID 83406-6717 | 2007-04-02 |
| 1346378304 | I Care Optical LLC | Eyewear Supplier (Equipment, not the service) | 1017 12th Ave S, Nampa, ID 83651-4660 | 2007-03-01 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
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.