SHOPKO STORES OPERATING CO. LLC (NPI# 1073565180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073565180 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 174 |
| Practice Address |
2323 W Pioneer Pkwy Peoria IL 61615-1833 |
| Practice Telephone | 3096914815 |
| Mailing Telephone | 3096914815 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-09-28 |
| 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 |
|---|---|---|---|
| EYEMED | CP230-16 | 01 | |
| VIP | 014174 | 01 | |
| MEDICARE | 17691 | 01 | |
| AVESIS | 35458 | 01 | |
| DAVIS | 42575 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 174 | 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 |
2323 W PIONEER PKWY |
| City | PEORIA |
| State | IL |
| Zip Code | 61615-1833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538195300 | Shopko Stores Operating Co. LLC | Durable Medical Equipment & Medical Supplies | 2323 W Pioneer Pkwy, Peoria, IL 61615-1833 | 2006-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627906 | Lance Jay Bucher | Occupational Therapist | 8600 Il-91, Peoria, IL 61615 | 2020-10-22 |
| 1093327496 | Angela Mitchell | Speech-Language Pathologist | 3903 W Ridgeview Dr, Peoria, IL 61615 | 2020-08-18 |
| 1578110680 | Emily E Buenting | Audiologist | 8600 Il Route 91, Suite 300, Peoria, IL 61615 | 2019-08-22 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1487169207 | Heather Hart | Registered Nurse | 9016 N. Scrimshaw Dr. Apt 104, Peoria, IL 61615 | 2017-12-04 |
| 1528586849 | Leanne Runyon | Speech-Language Pathologist | 10723 Collett Dr., Peoria, IL 61615 | 2017-09-07 |
| 1467974196 | Elizabeth A Mcleod | Nurse Practitioner | 8600 Illinois Route 91, Suite 130, Peoria, IL 61615 | 2017-07-14 |
| 1790223022 | Janet Warner | Counselor | 8914 North Prarie Court, Peoria, IL 61615 | 2017-02-07 |
| 1437524022 | Brooke Bisping | Dietitian, Registered | 7610 North Orange Prairie Road, Peoria, IL 61615 | 2015-12-08 |
| 1003292111 | Crystal Ann Casper | Dietitian, Registered | 7610 N Orange Prarie Road, Peoria, IL 61615 | 2015-07-31 |
| Find all providers in zip 61615 | ||||
| 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 |
|---|---|---|---|---|
| 1598928707 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 9780 W Northern Ave Ste 1120, Peoria, AZ 85345-4607 | 2008-07-08 |
| 1518013200 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 4530 N. Brandywine Drive, Peoria, IL 61614 | 2007-01-26 |
| 1851441646 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 10140 N 91st Ave, Peoria, AZ 85345-8310 | 2007-01-12 |
| 1851457089 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2200 W War Memorial Dr, Peoria Northwoods Mall, Peoria, IL 61613-1000 | 2006-12-30 |
| 1639245327 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 4203 A1-a4 North Sheridan, Peoria, IL 61614-5951 | 2006-11-27 |
| 1083158372 | Jak Enterprises Dba Jak Optical Laboratories | Eyewear Supplier (Equipment, not the service) | 8309 N Knoxville Ave, Peoria, IL 61615-2170 | 2016-12-06 |
| 1700336757 | Hw Holdings | Eyewear Supplier (Equipment, not the service) | 5116 N Big Hollow Rd, Peoria, IL 61615-3511 | 2016-10-13 |
| 1629261003 | See Optical | Eyewear Supplier (Equipment, not the service) | 9127 W Thunderbird Rd, #104, Peoria, AZ 85381-4887 | 2007-08-20 |
| 1801086780 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 24890 N Lake Pleasant Pkwy, Peoria, AZ 85383-1348 | 2007-07-27 |
| 1285779546 | Wyman Sicher Eye Associates Sc | Eyewear Supplier (Equipment, not the service) | 8921 N Wood Sage Rd, Peoria, IL 61615-7822 | 2007-02-21 |
| Find all providers in PEORIA | ||||
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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.