SHOPKO STORES OPERATING CO. LLC (NPI# 1164475752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164475752 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 064 |
| Practice Address |
2100 Caldwell Blvd Nampa ID 83651-1510 |
| Practice Telephone | 2084666895 |
| Mailing Telephone | 2084666895 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-08-03 |
| 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 | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| EYEMED | 213121-7 | 01 | |
| DAVIS VISION | 42500 | 01 | |
| VIP | 014064 | 01 | |
| MEDICARE | 17713 | 01 | |
| UWG | 410985054-4064 | 01 | |
| ID | 806430101 | 05 | |
| ID | 000309900 | 05 | |
| MEDICARE | 1379400 | 01 | |
| AVESIS | 35449 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 064 | 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 |
2100 CALDWELL BLVD |
| City | NAMPA |
| State | ID |
| Zip Code | 83651-1510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659324960 | Joy Gayle Johnson | Optometrist | 2100 Caldwell Blvd, Nampa, ID 83651-1510 | 2006-05-18 |
| 1699022962 | Thomas Joseph Statz | Pharmacist | 2100 Caldwell Blvd, Nampa, ID 83651-1510 | 2012-08-06 |
| 1346597606 | Timothy F Swain | Pharmacist | 2100 Caldwell Blvd, Nampa, ID 83651-1510 | 2012-08-06 |
| 1396853974 | Mark Matthew Mckell | Optometrist | 2100 Caldwell Blvd, Nampa, ID 83651-1510 | 2006-08-25 |
| 1295780815 | Shopko Stores Operating Co LLC | Pharmacy | 2100 Caldwell Blvd, Nampa, ID 83651-1510 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376090985 | Stephen Michael Wren | Physician Assistant | 11035 W Karcher Rd, Nampa, ID 83651 | 2016-09-01 |
| 1104203157 | Jeremy Thorson | Social Worker | 456 West Orchard Ave., Apt D305, Nampa, ID 83651 | 2015-04-29 |
| 1134527708 | Community Health Clinics Inc | Clinic/Center | 207 1st Street S, Nampa, ID 83651 | 2014-12-15 |
| 1326455429 | Michelle Murchie | Pharmacist | 175 S. Middleton Rd, Nampa, ID 83651 | 2014-07-21 |
| 1700215373 | Stanley A Gillett | Chiropractor | 107 14th Ave S, Nampa, ID 83651 | 2013-11-04 |
| 1477996205 | James L Fries | Counselor | 847 Park Centre Way, Suite 5, Nampa, ID 83651 | 2013-04-11 |
| 1023367240 | Erin Westfall | Speech-Language Pathologist | 168 Mcclure Avenue, Nampa, ID 83651 | 2012-09-04 |
| 1487949475 | Erik Steven Linn | Family Medicine | 11035 W. Karcher Road, Nampa, ID 83651 | 2011-06-17 |
| 1720398647 | At Your Service Home Health Care LLC | In Home Supportive Care | 321 2nd St S Ste 103, Nampa, ID 83651 | 2010-10-13 |
| 1144544206 | Petra Morrison | Community/Behavioral Health | 1031 W. Sanetta St., Nampa, ID 83651 | 2010-03-18 |
| Find all providers in zip 83651 | ||||
| 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 |
|---|---|---|---|---|
| 1346378304 | I Care Optical LLC | Eyewear Supplier (Equipment, not the service) | 1017 12th Ave S, Nampa, ID 83651-4660 | 2007-03-01 |
| 1902297120 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 16700 N Market Place Blvd, Nampa, ID 83687-7909 | 2015-02-10 |
| 1538567524 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 16449 Midland Blvd, Nampa, ID 83687-5222 | 2014-12-08 |
| 1043374812 | Jorge A. Martinez, Md, Pa | Eyewear Supplier (Equipment, not the service) | 1615 12th Ave Rd Ste B, Nampa, ID 83686-6184 | 2006-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972169357 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2331 Thain Grade Ste 101, Lewiston, ID 83501-4119 | 2019-05-11 |
| 1063078442 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 212 W Ironwood Dr Ste B&c, Coeur D Alene, ID 83814-1403 | 2019-05-11 |
| 1972096469 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 4013 Yellowstone Ave Ste D&e, Chubbuck, ID 83202-1932 | 2018-06-11 |
| 1023528320 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1605 Blue Lakes Blvd N # A, Twin Falls, ID 83301-3322 | 2017-10-02 |
| 1255757738 | Peabody Optical | Eyewear Supplier (Equipment, not the service) | 409 S 8th St Ste 101, Boise, ID 83702-7136 | 2014-03-08 |
| 1114268257 | Eyemart Express Ltd | Eyewear Supplier (Equipment, not the service) | 2990 S 25th E, Idaho Falls, ID 83404-6515 | 2013-03-14 |
| 1720212632 | Walmart Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 1551 Washington St. N, Twin Falls, ID 83301 | 2009-05-06 |
| 1275715757 | Panhandle Eye Clinics Chartered | Eyewear Supplier (Equipment, not the service) | 704 W College Ave, St Maries, ID 83861-1824 | 2007-11-27 |
| 1447439674 | The Frame Joint | Eyewear Supplier (Equipment, not the service) | 7905 W Ustick Rd, Suite E, Boise, ID 83704-5001 | 2007-10-24 |
| 1255452843 | Optical Illusions Inc | Eyewear Supplier (Equipment, not the service) | 3160 E 17th St, Suite 150, Ammon, ID 83406-6717 | 2007-04-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO. LLC.
| 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.