SHOPKO STORES OPERATING CO. LLC (NPI# 1063464063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063464063 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 106 |
| Practice Address |
905 S 24th St W Billings MT 59102-7408 |
| Practice Telephone | 4066527297 |
| Mailing Telephone | 4066527297 |
| Enumeration Date | 2006-05-17 |
| 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 |
|---|---|---|---|
| MEDICARE | 17879 | 01 | |
| MEDICARE | 000084251 | 01 | |
| VIP | 014106 | 01 | |
| MT | 0551044 | 05 | |
| AVESIS | 35490 | 01 | |
| EYEMED | CP2230-23 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 106 | 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 |
905 S 24TH ST W |
| City | BILLINGS |
| State | MT |
| Zip Code | 59102-7408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619264215 | Margo L Allen | Pharmacist | 905 S 24th St W, Billings, MT 59102-7408 | 2011-07-02 |
| 1760435531 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 905 S 24th St W, Billings, MT 59102-7408 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700402336 | Stephanie Diane Adkins | Counselor | 1726 Lampman Dr., Billings, MT 59102 | 2020-06-19 |
| 1366072563 | Carrie L Barton | Assistant Behavior Analyst | 1701 Avenue E Suite A, Billings, MT 59102 | 2020-01-16 |
| 1407418080 | Lori Lyn Strickler | Massage Therapist | 2901 Monad Road, Apt. 99, Billings, MT 59102 | 2019-07-03 |
| 1649754300 | Native American Development Corporation | Clinic/Center | 1230 North 30th Street, Billings, MT 59102 | 2018-09-19 |
| 1396235818 | Better Times Recovery Services LLC | Clinic/Center | 1925 Grand Ave Ste 103, Billings, MT 59102 | 2018-05-10 |
| 1982118428 | Family Support Network | Counselor | 1002 10th Street West, Suite 1, Billings, MT 59102 | 2017-11-20 |
| 1598281859 | Billings Clinic Specialty Supplies and Services, LLC | Durable Medical Equipment & Medical Supplies | 1015 Broadwater Ave Ste 102, Billings, MT 59102 | 2017-08-18 |
| 1326564857 | Billings Clinic Specialty Supplies and Services, LLC | Pharmacy | 1015 Broadwater Ave Ste 101, Billings, MT 59102 | 2017-08-16 |
| 1326586124 | Bailey K. Wilson | Behavior Technician | 3101 Lynn Ave., Apt. #3, Billings, MT 59102 | 2017-02-01 |
| 1588108120 | Angela Grimm | Counselor | 1200 30th St W, Billings, MT 59102 | 2016-12-16 |
| Find all providers in zip 59102 | ||||
| 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 |
|---|---|---|---|---|
| 1881924413 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 4420 King Avenue East, Billings, MT 59101 | 2010-01-04 |
| 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 |
| 1841656907 | Marion Opticans | Eyewear Supplier (Equipment, not the service) | 1212 Grand Ave, Suite 14, Billings, MT 59102 | 2016-01-05 |
| 1194116327 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 2290 King Ave W, Billings, MT 59102-7415 | 2015-02-10 |
| 1871991935 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 795 King Park Dr, Suite 3, Billings, MT 59102-6267 | 2014-12-05 |
| 1972849883 | Billings Clinic | Eyewear Supplier (Equipment, not the service) | 801 N 29th St, Billings, MT 59101-0905 | 2012-12-20 |
| 1467758920 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 111 S 24th St W, Billings, MT 59102-5600 | 2011-02-01 |
| 1821288374 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 111 S 24th St W, Rimrock Mini Mall, Billings, MT 59102-5600 | 2007-07-31 |
| 1437354834 | Mcbride & Mcbride Optometrists, P.C. | Eyewear Supplier (Equipment, not the service) | 2120 Grand Ave, Billings, MT 59102-2603 | 2007-06-18 |
| 1013041292 | Walman Optical Company | Eyewear Supplier (Equipment, not the service) | 2747 Enterprise Ave, Unit 3, Billings, MT 59102-7412 | 2007-03-16 |
| Find all providers in BILLINGS | ||||
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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.