SHOPKO STORES OPERATING CO. LLC (NPI# 1902858970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902858970 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 009 |
| Practice Address |
1306 N Central Ave Marshfield WI 54449-1507 |
| Practice Telephone | 7153878608 |
| Mailing Telephone | 7153878608 |
| Enumeration Date | 2006-05-17 |
| 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 |
|---|---|---|---|
| MEDICARE | 87831 | 01 | |
| VIP | 014009 | 01 | |
| DAVIS | 42566 | 01 | |
| MEDICARE | 17640 | 01 | |
| WI | 38416900 | 05 | |
| EYEMED | CP2230-81 | 01 | |
| NVA | 410985054-4009 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 009 | 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 |
1306 N CENTRAL AVE |
| City | MARSHFIELD |
| State | WI |
| Zip Code | 54449-1507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730130733 | James Eugene Feneli | Optometrist | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2006-05-14 |
| 1912322348 | Nathan Krall | Pharmacist | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2014-02-21 |
| 1578909578 | David Alan Bushee | Pharmacist | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2013-05-16 |
| 1245527027 | Margaret Wolan | Optometrist | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2011-06-30 |
| 1881805364 | Margaret Mclean, Lacey Hyde | Pharmacist | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2007-05-25 |
| 1194840074 | Keith Koscielski | Pharmacist | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2007-03-20 |
| 1528013133 | Shopko Stores Operating Co LLC | Pharmacy | 1306 N Central Ave, Marshfield, WI 54449-1507 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578125415 | Natalia Rodriguez Luquerna | Student in an Organized Health Care Education/Training Program | 100 N Oak Ave, Marshfield, WI 54449 | 2019-07-01 |
| 1396221636 | Candace R Delis | Counselor | 252 South Central, Suite 21, Marshfield, WI 54449 | 2018-07-18 |
| 1811489206 | Gateways Counseling Services, LLC | Counselor | 1905 S Central Ave, Marshfield, WI 54449 | 2018-06-01 |
| 1821542739 | Mark Ridder | Internal Medicine | M120 Highway 97, Marshfield, WI 54449 | 2016-08-09 |
| 1295187441 | Trina D Howard | Social Worker | 501 S. Cherry Ave, Suite 5, Marshfield, WI 54449 | 2016-07-11 |
| 1427403062 | Kristi Trecartin | Speech-Language Pathologist | 100 North Oak Avenue, Marshfield, WI 54449 | 2016-05-02 |
| 1093171498 | Mchs Hospitals, Inc. | General Acute Care Hospital | 1001 N. Oak Ave, Marshfield, WI 54449 | 2016-01-14 |
| 1467822759 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 1000 N. Oak Ave, Marshfield, WI 54449 | 2015-09-30 |
| 1346636743 | Jeanne Schreiner | Clinical Nurse Specialist | 611 Saint Joseph's Ave, Ministry Saint Joseph's Hospital, Marshfield, WI 54449 | 2015-04-13 |
| 1215336318 | Margaret Ann Chen | Medical Genetics, Ph.D. Medical Genetics | 3800 S. Business Park Ave., Marshfield, WI 54449 | 2014-08-14 |
| Find all providers in zip 54449 | ||||
| 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 |
|---|---|---|---|---|
| 1225694748 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 717 S Central Ave, Marshfield, WI 54449-4106 | 2019-05-10 |
| 1003051806 | Kramer & Newcomb O.d., P.C. | Eyewear Supplier (Equipment, not the service) | 1350 Spur Dr, Suite 150, Marshfield, MO 65706-2344 | 2008-12-08 |
| 1356528418 | Dr. Leo Donovan | Eyewear Supplier (Equipment, not the service) | 19 Webster Sq, Marshfield, MA 02050-3468 | 2008-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658772 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1073 E Johnson St, Fond Du Lac, WI 54935-8919 | 2020-10-27 |
| 1578170247 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 120 N Grand Ave Ste 102, Sun Prairie, WI 53590-9007 | 2020-09-28 |
| 1639784622 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2268 W Mason St, Green Bay, WI 54303-4707 | 2020-09-15 |
| 1427669746 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1607 Losey Blvd S, La Crosse, WI 54601-6151 | 2020-08-11 |
| 1710598032 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 631 Hometown Cir Ste 106, Verona, WI 53593-1561 | 2020-08-11 |
| 1871138073 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 723 Main Ave, Depere, WI 54115 | 2019-11-12 |
| 1558903815 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 422 Gammon Pl, Madison, WI 53719-1026 | 2019-10-08 |
| 1669013256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 123 N Mall Dr, Grand Chute, WI 54913-8531 | 2019-10-04 |
| 1952962763 | Martell Eyecare, LLC | Eyewear Supplier (Equipment, not the service) | 703 Third Street, Marathon, WI 54448 | 2019-06-23 |
| 1932767316 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1440 Capital Drive, Suite B, Pewaukee, WI 53072 | 2019-05-31 |
| Find all providers with the same taxonomy | ||||
| City | MARSHFIELD |
| Zip Code | 54449 |
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.