SHOPKO STORES OPERATING CO. LLC (NPI# 1902859515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902859515 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 062 |
| Practice Address |
301 Northwest Byp Great Falls MT 59404-4125 |
| Practice Telephone | 4067279724 |
| Mailing Telephone | 4067279724 |
| 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 |
|---|---|---|---|
| AVESIS | 35491 | 01 | |
| MEDICARE | 17877 | 01 | |
| MT | 0550576 | 05 | |
| EYEMED | 213121-20 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 062 | 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 |
| 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 |
301 NORTHWEST BYP |
| City | GREAT FALLS |
| State | MT |
| Zip Code | 59404-4125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255748414 | Colleen Johnson | Pharmacist | 301 Northwest Byp, Great Falls, MT 59404-4125 | 2014-07-18 |
| 1508819376 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 301 Northwest Byp, Great Falls, MT 59404-4125 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629504154 | Shawna Renee Applegate | Nurse Practitioner | 115 4th St S., Great Falls, MT 59404 | 2017-05-03 |
| 1093267213 | Cara Firman | Counselor | 3300 3rd St Ne, Great Falls, MT 59404 | 2016-11-04 |
| 1457803900 | Benjamin Huempfner | Counselor | 1205 1st Ave Nw, Great Falls, MT 59404 | 2016-11-01 |
| 1649675471 | Stephen Trautman | Pharmacist | 1000 3rd Steet Nw, Great Falls, MT 59404 | 2014-10-22 |
| 1457765851 | Complete Eye Care Pllc | Optometrist | 1012 1st Ave Nw, Great Falls, MT 59404 | 2014-06-13 |
| 1871923714 | William Joshu | Physician Assistant | 25 14th Avenue N.w., Great Falls, MT 59404 | 2013-11-13 |
| 1679839369 | Joelene Sharon (o'neill) Goodover | Counselor | 803 Forest Ave., Great Falls, MT 59404 | 2012-04-06 |
| 1942512728 | Amy Jo Jamieson | Counselor | 600 Ave. A, Valley View School, Great Falls, MT 59404 | 2010-07-08 |
| 1942527890 | Matthew Clayton Taecker | Emergency Medicine | 113 38th Ave Ne, Great Falls, MT 59404 | 2010-04-30 |
| 1720212897 | Dana Marie Thompson | Military Health Care Provider | 819 Rhs/sg, 6944 Goddard Drive, Malmstrom Afb, MT 59404 | 2009-05-05 |
| Find all providers in zip 59404 | ||||
| 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 |
|---|---|---|---|---|
| 1285992255 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 7200 Perimeter Road, Building 1340, Great Falls, MT 59402-6856 | 2012-04-27 |
| 1477677623 | Walman Optical Company | Eyewear Supplier (Equipment, not the service) | 410 Central Avenue, 320 Strain Building, Great Falls, MT 59401 | 2007-03-16 |
| 1194859140 | Dustin Optical Inc. | Eyewear Supplier (Equipment, not the service) | 2800 11th Ave S Ste 19, Great Falls, MT 59405-5263 | 2007-03-14 |
| 1932507894 | Eye Mart Express LLC | Eyewear Supplier (Equipment, not the service) | 1525 10th Ave S, Great Falls, MT 59405-2608 | 2014-12-09 |
| 1114354958 | Eyemart Express Ltd | Eyewear Supplier (Equipment, not the service) | 1525 10th Ave S, Great Falls, MT 59405-2608 | 2013-10-10 |
| 1588959613 | Carl A Swanson Od | Eyewear Supplier (Equipment, not the service) | 2509 7th Ave S, Suite C3, Great Falls, MT 59405-3030 | 2011-06-16 |
| 1619173580 | True Vision Clinic Pllc | Eyewear Supplier (Equipment, not the service) | 1900 4th St Ne, Suite 5, Great Falls, MT 59404-1996 | 2007-06-26 |
| 1992804900 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 1200 10th Ave S, Holiday Village Mall Ste #25, Great Falls, MT 59405-4413 | 2006-09-22 |
| 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 |
| 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 |
| 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 | ||||
| City | GREAT FALLS |
| Zip Code | 59404 |
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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.