SHOPKO STORES OPERATING CO. LLC (NPI# 1750334348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750334348 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 112 |
| Practice Address |
3101 N Montana Ave Helena MT 59602-7813 |
| Practice Telephone | 4064438860 |
| Mailing Telephone | 4064438860 |
| Enumeration Date | 2006-05-18 |
| 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 |
|---|---|---|---|
| MEDICARE | 000084250 | 01 | |
| MEDICARE | 17880 | 01 | |
| EYEMED | CP2230-24 | 01 | |
| VIP | 014112 | 01 | |
| MT | 0551096 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 112 | 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 |
| 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 |
3101 N MONTANA AVE |
| City | HELENA |
| State | MT |
| Zip Code | 59602-7813 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124072921 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 3101 N Montana Ave, Helena, MT 59602 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255819868 | Jacob Kreamer | Pharmacist | 3195 E Custer Ave, Helena, MT 59602 | 2018-08-06 |
| 1013364819 | Sierra Richmond | Physical Therapist | 3345 Colton Dr Ste A, Helena, MT 59602 | 2016-05-21 |
| 1932556065 | First Words Speech and Language Clinic | Speech-Language Pathologist | 3774 Juliet Drive, Helena, MT 59602 | 2016-05-18 |
| 1568837730 | Leigh Fahlquist, LLC | Community/Behavioral Health | 1159 Toucan Rd., Helena, MT 59602 | 2015-12-14 |
| 1467824912 | Coordicare Inc | Clinic/Center | 1223 Stetson Rd, Helena, MT 59602 | 2015-10-23 |
| 1659675197 | Jesse Miller Mumford Heidi | Social Worker | 3240 Dredge Dr., Helena, MT 59602 | 2010-12-24 |
| 1194988543 | Jonathan Spencer Griffin | Family Medicine | 1223 Stetson Rd., Helena, MT 59602 | 2008-07-07 |
| 1568688976 | Tammie R. Espenlaub | Nurse Practitioner | 2029 9th Ave, Suite 1, Helena, MT 59602 | 2007-04-17 |
| 1780704528 | Barbara Jean Bayer | Acupuncturist | 3404 Cooney Dr, Bldg #2, Helena, MT 59602 | 2007-03-29 |
| 1023134293 | Brian W Abbott | Neuromusculoskeletal Medicine & OMM | 3150 N Montana Ave Ste A, Helena, MT 59602 | 2007-03-21 |
| Find all providers in zip 59602 | ||||
| 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 |
|---|---|---|---|---|
| 1104101211 | Quality Vision Care | Eyewear Supplier (Equipment, not the service) | 1040 Partridge Pl Ste 10, Helena, MT 59602-0518 | 2011-10-20 |
| 1871984153 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 2195 E Custer Ave, Helena, MT 59602-1217 | 2015-02-09 |
| 1124072921 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 3101 N Montana Ave, Helena, MT 59602 | 2006-05-19 |
| 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 |
| 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 |
| 1568685790 | Pearle Vision | Eyewear Supplier (Equipment, not the service) | 20 N Main St Ste B13, Kalispell, MT 59901-4080 | 2007-04-10 |
| 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.