SHOPKO STORES OPERATING CO LLC (NPI# 1023069499) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023069499 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO OPTICAL 093 |
| Practice Address |
60 Ne Bend River Mall Dr Bend OR 97701-7528 |
| Practice Telephone | 5413856079 |
| Mailing Telephone | 5413856079 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2008-03-19 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 022688 | 05 | |
| DAVIS VISION | 42573 | 01 | |
| MEDICARECOMPLETE | 17679 | 01 | |
| EYEMED | CP2230-33 | 01 | |
| OR | 005251 | 05 | |
| VIP | 014093 | 01 | |
| OR MEDICARE-NORIDIAN | 112254 | 01 | |
| AVESIS | 35508 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 093 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275017907 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1166 W Sunset Drive, Suite F100, Waukesha, WI 53189 | 2018-09-19 |
| 1871076968 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1810 Jackson St, Oshkosh, WI 54901-2204 | 2018-09-13 |
| 1427547082 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 10996 N Port Washington Rd, Mequon, WI 53092 | 2018-05-08 |
| 1912454505 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 908 Nw 6th St, Tulia, TX 79088 | 2016-09-01 |
| 1821545419 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 67 Selkirk Way, Oldtown, ID 83822 | 2016-09-01 |
| 1740736586 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 94 North 400 East, Delta, UT 84624 | 2016-08-31 |
| 1639625064 | Shopko Stores Operating Co LLC | Pharmacy | 1001 N Center Ave, Hardin, MT 59034-1101 | 2016-08-26 |
| 1649726076 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1635 E Highway 40, Ballard, UT 84066-5217 | 2016-08-26 |
| 1841745155 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 301 E Us Highway 20, Gordon, NE 69343-1650 | 2016-08-17 |
| 1821441205 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 6355 Main St, Bonners Ferry, ID 83805-8519 | 2016-07-20 |
| Street Address |
60 NE BEND RIVER MALL DR |
| City | BEND |
| State | OR |
| Zip Code | 97701-7528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164972394 | Kasey Ann Swanstrom | Pharmacist | 60 Ne Bend River Mall Dr, Bend, OR 97703-7528 | 2016-10-12 |
| 1275967382 | Gerald Dana Radant | Pharmacist | 60 Ne Bend River Mall Dr, Bend, OR 97701-7528 | 2013-08-26 |
| 1063785277 | Kerst Bosma | Pharmacist | 60 Ne Bend River Mall Dr, Bend, OR 97701-7528 | 2012-02-17 |
| 1699048256 | Jonathan Carney | Pharmacist | 60 Ne Bend River Mall Dr, Bend, OR 97701-7528 | 2012-02-13 |
| 1659309961 | Leonard Louis Langeliers | Optometrist | 60 Ne Bend River Mall Dr, Bend, OR 97701-7528 | 2006-06-28 |
| 1104878628 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 60 Ne Bend River Mall Dr, Bend, OR 97701-7528 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104465525 | Andrew Kyle Burzynski | Denturist | 853 Ne 4th St., Bend, OR 97701 | 2020-01-02 |
| 1013480714 | Andrew Traut | Specialist/Technologist | Oregon State Force Lab, 2200 Ne Neff Rd Suite 202, Bend, OR 97701 | 2019-01-04 |
| 1871063917 | Calley Asbill, Nd LLC | Chiropractor | 2146 Ne 4th Street, Suite 160, Bend, OR 97701 | 2018-12-02 |
| 1902372212 | Carisa S Battin | Counselor | 361 Ne Franklin Avenue Bldg E #4, Bend, OR 97701 | 2018-10-15 |
| 1366921223 | Hillside Eye Center LLC | Ophthalmology | 625 Nw Colorado Avenue, Bend, OR 97701 | 2018-08-11 |
| 1528545514 | Kellie Michiko Kawasaki-jones | Dentist | 62968 Ob Riley Road, Suite 12, Bend, OR 97701 | 2018-07-23 |
| 1992255327 | Shelby Chiropractic | Chiropractor | 561 Ne Bellevue Dr Ste 102, Bend, OR 97701 | 2016-10-10 |
| 1144671520 | Kevin Richard Pett | Acupuncturist | 39 Nw Louisanna Ave., Hawthorn Healing Arts Center, Bend, OR 97701 | 2016-06-27 |
| 1912357500 | Sheldon Shawn Doveri | Driver | 233 Nw Revere Ave, Bend, OR 97701 | 2016-06-15 |
| 1740647411 | Anne Power | Homeopath | 2100 Ne Neff Rd Suite B, Bend, OR 97701 | 2016-01-26 |
| Find all providers in zip 97701 | ||||
| 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 |
|---|---|---|---|---|
| 1467823518 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 3148 N Highway 97, Suite B-1, Bend, OR 97703-7514 | 2015-10-15 |
| 1396893962 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 3044 N Hwy 97, Bend River Mall, Bend, OR 97701-7512 | 2007-01-08 |
| 1457398315 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 20120 Pinebrook Blvd, Bend, OR 97702-2537 | 2006-06-01 |
| 1568852069 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 2500 Ne Highway 20, Bend, OR 97701-6277 | 2015-02-04 |
| 1659542223 | Visionworks, Inc | Eyewear Supplier (Equipment, not the service) | 63455 N Hwy 97 Ste 75, Bend, OR 97701-6761 | 2008-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255827689 | Woodburn Eye Center, LLC | Eyewear Supplier (Equipment, not the service) | 580 Glatt Cir, Woodburn, OR 97071-7690 | 2018-07-09 |
| 1518473297 | Asterix Eyewear | Eyewear Supplier (Equipment, not the service) | 4936 Se Foster Rd, Portland, OR 97206-3037 | 2017-12-18 |
| 1831616929 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 817 Nw 23rd Ave, Portland, OR 97210-3003 | 2017-08-29 |
| 1568993988 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 9300 Sw Washington Square Rd, Portland, OR 97223-4428 | 2017-03-27 |
| 1871048090 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 30020 Sw Boones Ferry Rd, Wilsonville, OR 97070-8912 | 2016-08-17 |
| 1871962951 | Optical Shop Equipment Inc | Eyewear Supplier (Equipment, not the service) | 341 Nw Medical Loop, Suite 120, Roseburg, OR 97471-5540 | 2015-09-18 |
| 1326460221 | Mt. Hood Eye Care Corporation | Eyewear Supplier (Equipment, not the service) | 36840 Industrial Way Ste D, Sandy, OR 97055-9254 | 2014-01-11 |
| 1528301173 | Treondaus Garnett Morman | Eyewear Supplier (Equipment, not the service) | 1135 Santiam Hwy Se, Albany, OR 97321-3156 | 2013-04-02 |
| 1750611372 | Focal Point | Eyewear Supplier (Equipment, not the service) | 2002 Highway 101, North, Florence, OR 97439-0155 | 2010-01-04 |
| 1043449895 | Eyemart Express, Ltd. | Eyewear Supplier (Equipment, not the service) | 1680 Coburg Rd, Suite100, Eugene, OR 97401-4869 | 2009-07-14 |
| 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.