SHOPKO STORES OPERATING CO. LLC (NPI# 1528010550) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528010550 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 128 |
| Practice Address |
1370 Us Highway 2 E Kalispell MT 59901-3221 |
| Practice Telephone | 4062571278 |
| Mailing Telephone | 4062571278 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-04-24 |
| 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 | ||
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VIP | 014128 | 01 | |
| AVESIS | 35493 | 01 | |
| MEDICARE | 000083891 | 01 | |
| MEDICARE | 17881 | 01 | |
| MT | 0551174 | 05 | |
| EYEMED | CP2230-25 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 128 | 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 |
1370 US HIGHWAY 2 E |
| City | KALISPELL |
| State | MT |
| Zip Code | 59901-3221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558719096 | Cheryl Gervasi | Pharmacist | 1370 Us Highway 2 E, Kalispell, MT 59901-3221 | 2016-05-25 |
| 1003240748 | Mark Steven Walters | Pharmacist | 1370 Us Highway 2 E, Kalispell, MT 59901-3221 | 2013-08-29 |
| 1073882817 | Amber Lynn Windnagle | Pharmacist | 1370 Us Highway 2 E, Kalispell, MT 59901-3221 | 2011-12-23 |
| 1679526446 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1370 Us Highway 2 E, Kalispell, MT 59901-3221 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982226650 | Mountain Physical Therapy and Fitness Center LLC | Physical Medicine & Rehabilitation | 2593 Highway 2 East, Suite 6, Kalispell, MT 59901 | 2020-05-15 |
| 1164058350 | Jessica Leeann Abell | Physical Therapist | 1825 Highway 93 S. Suite C, Kalispell, MT 59901 | 2020-03-19 |
| 1588216535 | Diversified Therapeutic Services, Pllc | Clinic/Center | 30 E Washinton St, Suite A, Kalispell, MT 59901 | 2019-07-10 |
| 1467986216 | Jill Shaver | Counselor | 285 2nd Avenue Wn, Suite #100, Kalispell, MT 59901 | 2017-04-19 |
| 1003270810 | Angela Otto | Counselor | 17 2nd St E Ste 204, Kalispell, MT 59901 | 2016-04-07 |
| 1548626989 | Pamela Greskowiak | Counselor | 2282 Hwy 93 South, Suite #1, Kalispell, MT 59901 | 2016-01-14 |
| 1063894921 | Joel Booth | Dentist | 690 N Meridian Rd Ste 106, Kalispell, MT 59901 | 2015-06-26 |
| 1982085841 | Heather Reddig | Specialist | 751 Snowberry Trail, Kalispell, MT 59901 | 2015-06-16 |
| 1497147193 | Patricia Greene Hall | Psychologist | 1035 1st Ave W Fl 3, Kalispell, MT 59901 | 2015-03-04 |
| 1720478886 | Lori Mariani | Social Worker | 1605 Danielson Road, Kalispell, MT 59901 | 2015-01-28 |
| Find all providers in zip 59901 | ||||
| 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 |
|---|---|---|---|---|
| 1568685790 | Pearle Vision | Eyewear Supplier (Equipment, not the service) | 20 N Main St Ste B13, Kalispell, MT 59901-4080 | 2007-04-10 |
| 1063803344 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 2330 Us Highway 93 N, Kalispell, MT 59901-2547 | 2015-02-09 |
| 1801192372 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 20 N Main St, Kalispell Mall, Kalispell, MT 59901-4080 | 2011-02-01 |
| 1053564658 | Optical Shop of Kalispell | Eyewear Supplier (Equipment, not the service) | 35 Main St Ste B, Kalispell, MT 59901-4448 | 2008-10-28 |
| 1063603355 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 20 N Main St, Kalispell Mall, Kalispell, MT 59901-4080 | 2007-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225684020 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1715 S Reserve St, Missoula, MT 59801-4705 | 2019-08-16 |
| 1780061960 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 7200 Perimeter Rd., Bldg 1340, Malmstrom Afb, MT 59402 | 2015-04-27 |
| 1285992255 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 7200 Perimeter Road, Building 1340, Great Falls, MT 59402-6856 | 2012-04-27 |
| 1104101211 | Quality Vision Care | Eyewear Supplier (Equipment, not the service) | 1040 Partridge Pl Ste 10, Helena, MT 59602-0518 | 2011-10-20 |
| 1881924413 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 4420 King Avenue East, Billings, MT 59101 | 2010-01-04 |
| 1497949002 | Specticca Inc | Eyewear Supplier (Equipment, not the service) | 319 N Higgins Ave, Missoula, MT 59802-4537 | 2007-08-28 |
| 1831382605 | Jeffrey D. Heninger, O.d. Pllc | Eyewear Supplier (Equipment, not the service) | 203a Ridgewater Dr, Polson, MT 59860-8992 | 2007-08-24 |
| 1063603363 | Essilor Laboratories of America, Inc | Eyewear Supplier (Equipment, not the service) | 1002 10th St W Ste 3, Billings, MT 59102-5463 | 2007-08-05 |
| 1699965681 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2825 W Main, Gallatin Valley Mall #5d, Bozeman, MT 59718-3927 | 2007-07-26 |
| 1366654840 | Big Sky Optical | Eyewear Supplier (Equipment, not the service) | 14 South Montana, Butte, MT 59701-0000 | 2007-05-04 |
| Find all providers with the same taxonomy | ||||
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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.