SHOPKO PROPERTIES, LLC (NPI# 1518086099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518086099 |
| Entity Type | Organization |
| Organization Name | SHOPKO PROPERTIES, LLC |
| Practice Address |
700 Pilgrim Way Green Bay WI 54304-5263 |
| Mailing Address |
Po Box 19060 Green Bay WI 54307-9060 |
| Practice Telephone | 9204292211 |
| Practice Fax Number | 9204294349 |
| Mailing Telephone | 9204292211 |
| Mailing Fax Number | 9204294349 |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2015-12-28 |
| Authorized Official Name | MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9204297489 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | SHOPKO PROPERTIES, LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Street Address |
700 PILGRIM WAY |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5263 |
| 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 |
| 1316504970 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2019-05-20 |
| 1992007926 | Shopko Institutional Care Services | Durable Medical Equipment & Medical Supplies | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2010-11-24 |
| 1205090990 | Kyle J Klika | Optometrist | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2008-07-11 |
| 1386841385 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2007-07-02 |
| 1649215666 | Shopko Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| 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 |
|---|---|---|---|---|
| 1639784622 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2268 W Mason St, Green Bay, WI 54303-4707 | 2020-09-15 |
| 1194381509 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2300 Lineville Rd Ste 109, Green Bay, WI 54313-8859 | 2019-05-13 |
| 1710543228 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2360 Costco Way Ste 120, Green Bay, WI 54311-9210 | 2019-05-10 |
| 1659937159 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2621 S Oneida St Ste 104, Green Bay, WI 54304-5793 | 2019-05-10 |
| 1376743351 | Essilor Laboratories of America, Inc. | Eyewear Supplier (Equipment, not the service) | 2985 S Ridge Rd, Green Bay, WI 54304-5565 | 2007-07-19 |
| 1194870907 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 303 Bay Park Sq Ste 976, Green Bay, WI 54304-5104 | 2007-01-24 |
| 1487753927 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 191 Bay Parks Square Mall, Green Bay, WI 54304-5102 | 2006-09-21 |
| 1144327149 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1555 Green Bay Plaza, Green Bay, WI 54304-2143 | 2006-09-20 |
| 1952356644 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-05-23 |
| 1316504970 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2019-05-20 |
| Find all providers in GREEN BAY | ||||
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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.