SHOPKO STORES OPERATING CO. LLC (NPI# 1649223413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649223413 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 004 |
| Practice Address |
2430 E Mason St Green Bay WI 54302-3759 |
| Practice Telephone | 9204684642 |
| Mailing Telephone | 9204684642 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-02-11 |
| 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 |
|---|---|---|---|
| VIP | 014004 | 01 | |
| DAVIS | 42520 | 01 | |
| MEDICARE | 17636 | 01 | |
| WI | 38403100 | 05 | |
| NVA | 410985054-4004 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 004 | 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 |
2430 E MASON ST |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54302-3759 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962452052 | Shopko Stores Operating Company | Optometrist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2006-05-11 |
| 1629408745 | John Simonet | Pharmacist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2013-11-26 |
| 1154768547 | Susan Gilson | Pharmacist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2013-05-27 |
| 1013351287 | Lynn Marie Bond | Pharmacist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2013-04-18 |
| 1144574286 | Christine A Thomas | Pharmacist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2012-10-27 |
| 1578750766 | John Richard Hofmann | Pharmacist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2007-10-01 |
| 1538205380 | Gail P Bosco | Physician Assistant | 2430 E Mason St, Green Bay, WI 54302-3759 | 2007-01-29 |
| 1881797462 | Josephine M Mcintosh | Nurse Practitioner | 2430 E Mason St, Green Bay, WI 54302-3759 | 2006-09-07 |
| 1316049943 | Jennifer Ann Lenius | Physician Assistant | 2430 E Mason St, Green Bay, WI 54302-3759 | 2006-09-03 |
| 1609896042 | James L Schmonsky IIi | Optometrist | 2430 E Mason St, Green Bay, WI 54302-3759 | 2006-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659721371 | Carissa Marie Sawicki | Counselor | 1234 Main Street, Suite 21, 3rd Floor, Green Bay, WI 54302 | 2016-06-14 |
| 1891181459 | Shannon Rae Mullins | Registered Nurse | 2254 Imperial Ln, Green Bay, WI 54302 | 2015-04-10 |
| 1346667045 | David Howard Jadin | Dentist | 1245 Main St, Green Bay, WI 54302 | 2014-03-20 |
| 1407003577 | Abby Baumgart | Counselor | 1234-21 Main St, Green Bay, WI 54302 | 2008-08-20 |
| 1447441779 | Muller Eyecare Associates Ltd | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-08-01 |
| 1851385231 | Bornemann Nursing Home Inc | Skilled Nursing Facility | 226 Bornemann St, Green Bay, WI 54302 | 2005-08-31 |
| 1194188706 | Familia Dental Green Bay LLC | Dentist | 1931 Main St., Green Bay, WI 54302 | 2016-03-31 |
| 1255710125 | Kim Lawrence | Social Worker | 1234 Main St., St 21, 3rd Floor, Green Bay, WI 54302 | 2015-05-26 |
| 1255464533 | John Muller | Optometrist | 1776 E Mason St, Green Bay, WI 54302 | 2007-03-14 |
| 1851622005 | Michael Andrew Larkey | Social Worker | 815 Reber St, Green Bay, WI 54302-1116 | 2010-01-27 |
| Find all providers in zip 54302 | ||||
| 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 | ||||
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.