SHOPKO STORES OPERATING CO. LLC (NPI# 1952356644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952356644 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL |
| Practice Address |
700 Pilgrim Way Green Bay WI 54304-5263 |
| Mailing Address |
Po Box 19060 Green Bay WI 54307-9060 |
| Practice Telephone | 9204294218 |
| Practice Fax Number | 9204295218 |
| Mailing Telephone | 9204294218 |
| Mailing Fax Number | 9204295218 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-10-12 |
| Authorized Official Name | MR. 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 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
700 PILGRIM WAY |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316504970 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2019-05-20 |
| 1992007926 | Shopko Institutional Care Services | Durable Medical Equipment & Medical Supplies | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2010-11-24 |
| 1205090990 | Kyle J Klika | Optometrist | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2008-07-11 |
| 1386841385 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2007-07-02 |
| 1518086099 | Shopko Properties, LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2007-03-28 |
| 1649215666 | Shopko Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| 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 |
| 1316504970 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2019-05-20 |
| 1942483342 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 2320 Lineville Rd, Green Bay, WI 54313-8836 | 2007-12-10 |
| Find all providers in GREEN BAY | ||||
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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.