SHOPKO STORES OPERATING CO. LLC (NPI# 1124071758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124071758 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 120 |
| Practice Address |
405 W 8th St Monroe WI 53566-1063 |
| Practice Telephone | 6083283333 |
| Mailing Telephone | 6083283333 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-02-11 |
| 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 |
|---|---|---|---|
| WI | 38710500 | 05 | |
| EYEMED | CP2230-82 | 01 | |
| VIP | 014120 | 01 | |
| NVA | 41098054-4123 | 01 | |
| DAVIS | 42532 | 01 | |
| MEDICARE | 17661 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 120 | 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 |
405 W 8TH ST |
| City | MONROE |
| State | WI |
| Zip Code | 53566-1063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699727446 | David Allan Emmerich | Optometrist | 405 W 8th St, Monroe, WI 53566-1063 | 2006-05-17 |
| 1396295846 | Kayla Rackow | Pharmacist | 405 W 8th St, Monroe, WI 53566-1063 | 2016-10-08 |
| 1619319373 | Denise Murphy | Pharmacist | 405 W 8th St, Monroe, WI 53566-1063 | 2013-07-23 |
| 1659624831 | Jan Wartenweiler | Pharmacist | 405 W 8th St, Monroe, WI 53566-1063 | 2012-10-24 |
| 1053616128 | Michael Kuckes | Pharmacist | 405 W 8th St, Monroe, WI 53566-1063 | 2011-01-20 |
| 1013145952 | Christine Ann Ward | Optometrist | 405 W 8th St, Monroe, WI 53566-1063 | 2009-06-30 |
| 1053366773 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 405 W 8th St, Monroe, WI 53566-1063 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548752967 | Mariah Mohns | Occupational Therapy Assistant | N3150 Wi- 81, Monroe, WI 53566 | 2018-06-01 |
| 1811414907 | Yelena Gapchenko | Pharmacist | 515 22nd St., Monroe, WY 53566 | 2017-08-29 |
| 1508306283 | Hilary Domke | Occupational Therapist | N3150 Wi-81, Monroe, WI 53566 | 2017-03-01 |
| 1699132332 | Lisa Marty | Social Worker | N3152 Wi-81, Monroe, WI 53566 | 2016-01-26 |
| 1518223148 | Lauren Nibler Craddock | Dermatology | 412 18th Ave, Monroe, WI 53566 | 2012-04-09 |
| 1033482799 | Amber Gatdula | Physical Therapy Assistant | 2628 14th Street, Monroe, WI 53566 | 2012-02-10 |
| 1629361043 | Tammy Noble | Licensed Practical Nurse | N2546 Ullom Rd., Monroe, WI 53566 | 2011-05-18 |
| 1023331683 | Kristine Hudson | Registered Nurse | 1110 11th Street, Monroe, WI 53566 | 2010-03-10 |
| 1306005012 | Rosemary Ann Graham | Registered Nurse | 2413 5th Ave, Monroe, WI 53566 | 2008-06-06 |
| 1174702559 | Kelly Jo Jenson | Chiropractor | 1518 11th Street, Suite 1-2, Monroe, WI 53566 | 2007-11-01 |
| Find all providers in zip 53566 | ||||
| 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 |
|---|---|---|---|---|
| 1174130314 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 232 Larkin Dr, Monroe, NY 10950-4911 | 2020-09-30 |
| 1891340899 | Joseph E Humble and Raymond Haik, Ptrs | Eyewear Supplier (Equipment, not the service) | 1801 Auburn Ave, Monroe, LA 71201-5005 | 2019-08-06 |
| 1598263238 | Visioinworks, Inc | Eyewear Supplier (Equipment, not the service) | 2335 W Roosevelt Blvd Ste C, Monroe, NC 28110-0416 | 2018-01-29 |
| 1699800656 | Svs Vision Inc | Eyewear Supplier (Equipment, not the service) | 1349 N Telegraph Rd, Monroe, MI 48162-3374 | 2007-02-22 |
| 1356487490 | Pearle Vision Inc | Eyewear Supplier (Equipment, not the service) | 2121 N Monroe St, Frenchtown Square #235, Monroe, MI 48162-5316 | 2007-01-29 |
| 1659429165 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 4800 Millhaven Rd, Pecanland Mall, Monroe, LA 71203-9054 | 2007-01-08 |
| 1164588398 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2121 N Monroe, Frenchtown Square, Monroe, MI 48162-5316 | 2006-12-30 |
| 1770671349 | Jason Wonch Od and Associates A PC | Eyewear Supplier (Equipment, not the service) | 4700 Millhaven Road, Suite 1090, Monroe, LA 71203 | 2006-10-10 |
| 1558452284 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 19919 State Rte 2, Monroe Plaza, Monroe, WA 98272-2338 | 2006-09-27 |
| 1215971957 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 18805 State Rt #2, Suite A, Monroe, WA 98272 | 2006-06-15 |
| Find all providers in MONROE | ||||
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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.