SHOPKO STORES OPERATING CO. LLC (NPI# 1760435333) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760435333 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 150 |
| Practice Address |
3030 Wabash Ave Springfield IL 62704-6413 |
| Practice Telephone | 2176989721 |
| Mailing Telephone | 2176989721 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-01-30 |
| 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 |
|---|---|---|---|
| EYEMED | CP2521-6 | 01 | |
| MEDICARE | 17688 | 01 | |
| VIP | 014150 | 01 | |
| DAVIS | 42563 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 150 | 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 |
| 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 |
| 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 |
3030 WABASH AVE |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62704-6413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790711737 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 3030 Wabash Ave, Springfield, IL 62704-6413 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902394901 | Hillary Haaker | Occupational Therapist | 2035 W Iles, Suite C, Springfield, ID 62704 | 2018-04-25 |
| 1871095364 | Edward Doyle Slifer Sr. | Pathology | 2117 Greenside Drive, Spring Field, IL 62704 | 2018-03-01 |
| 1598263345 | Santarelli & Feller Dental Group | Dentist | 1140 Rickard Road, Suite B, Springfield, IL 62704 | 2018-01-26 |
| 1447774757 | Lisa Ann Rogers | Developmental Therapist | 2101 Lexington Dr, Apt 3, Springfield, IL 62704 | 2017-07-28 |
| 1730611286 | Mindi Rowe | Occupational Therapist | 2508 County Rd 4 1/2 E, Springfield, IL 62704 | 2017-04-03 |
| 1366992208 | Jayme Jordan | Contractor | 2409 Westchester Blvd, Springfield, IL 62704 | 2016-10-04 |
| 1154793974 | Dina Payne | Social Worker | 917 Clocktower Drive, Suite 600, Springfield, IL 62704 | 2015-10-21 |
| 1770959819 | James R Reynolds | Hearing Instrument Specialist | 2347 W Monroe St, Springfield, IL 62704 | 2015-08-12 |
| 1336576495 | Emily Jane Dungey | Counselor | 920 S Spring St Ste 1300, Springfield, IL 62704 | 2013-10-03 |
| 1942552161 | Jeannie Marie Hundley | Specialist/Technologist, Other | 2921 Monvale Drive, Springfield, IL 62704 | 2012-10-11 |
| Find all providers in zip 62704 | ||||
| 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 |
|---|---|---|---|---|
| 1174074140 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 101 White Oaks Mall, Springfield, IL 62704-0501 | 2016-10-14 |
| 1063962017 | Hw Holdings | Eyewear Supplier (Equipment, not the service) | 2806 Sw Plaza Dr, Springfield, IL 62704-6743 | 2016-10-13 |
| 1912456898 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 1250 Baltimore Pike & Sproul Rd, Springfield, PA 19064-2706 | 2016-10-03 |
| 1518390525 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 1006 Baltimore Pike, Store #n-8, Springfield, PA 19064-2836 | 2013-08-13 |
| 1528382256 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 104 White Oaks Mall, Springfield, IL 62704-6946 | 2010-03-24 |
| 1043457542 | Rlw, Inc. | Eyewear Supplier (Equipment, not the service) | 1850 S Glenstone Ave, Springfield, MO 65804-2303 | 2009-01-21 |
| 1285821066 | Vision Service Corporation | Eyewear Supplier (Equipment, not the service) | 2051 N Bechtle Ave Ste 130, Springfield, OH 45504-1583 | 2007-09-26 |
| 1316138266 | Ozarks Optical Laboratories, Inc. | Eyewear Supplier (Equipment, not the service) | 1845 W Arbor Ct, Springfield, MO 65807-5956 | 2007-08-06 |
| 1669663670 | 21st Century Optics Inc. | Eyewear Supplier (Equipment, not the service) | 53 Brown Ave, Springfield, NJ 07081-2901 | 2007-08-05 |
| 1184744310 | Springfield Mall Optical, Inc. | Eyewear Supplier (Equipment, not the service) | 6795 Springfield Mall, Springfield, VA 22150-1704 | 2007-03-30 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62704 |
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.