SHOPKO STORES OPERATING CO. LLC (NPI# 1174575500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174575500 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 4017 |
| Practice Address |
4161 2nd St S Saint Cloud MN 56301-3761 |
| Practice Telephone | 3202535994 |
| Mailing Telephone | 3202535994 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-04-15 |
| 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 |
|---|---|---|---|
| MN MA PRIMEWEST HEALTH | 03092036202 | 01 | |
| MN MA MEDICA CHOICE CARE | 2123169 | 01 | |
| MN BLUE PLUS CARE | 77168MA | 01 | |
| AVESIS | 35479 | 01 | |
| AVESIS | 35585 | 01 | |
| EYEMED | CP2230-22 | 01 | |
| MEDICARE | 17821 | 01 | |
| NATIONAL VISION ADMIN. | 410985054-4017 | 01 | |
| VIP | 014017 | 01 | |
| MN HEALTH PARTNERS | 23667 | 01 | |
| DAVIS | 42601 | 01 | |
| MN MA FIRST PLAN OF MN | 77166SH | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 4017 | 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 |
4161 2ND ST S |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56301-3761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427476241 | Michael Neuwirth | Pharmacist | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2014-03-29 |
| 1134546211 | Leslie Kiel | Pharmacist | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2014-03-26 |
| 1013154202 | Lori Ann Keppers | Pharmacist | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2009-01-10 |
| 1881634806 | Bryan David Lorenz | Optometrist | 4161 2nd St S, Shopko Optical, Saint Cloud, MN 56301-3761 | 2006-06-07 |
| 1609829464 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013528207 | Stephen Sean Jenkins | Psychologist | 720 Fourth Ave. S., Eastman Hall 305, Saint Cloud, MN 56301 | 2020-08-12 |
| 1316453442 | Amber Grengs | Behavior Technician | 3721 23rd St S Ste 201, Saint Cloud, MN 56301 | 2017-12-27 |
| 1124532999 | Ashley Aune Lewandowski | Chiropractor | 3333 W. Division St. Suite 122a, St. Cloud, MN 56301 | 2017-11-30 |
| 1962923680 | Inspired By You Home Care, LLC | Home Health | 2700 1st Street N, Suite 202, St Cloud, MN 56301 | 2017-07-03 |
| 1487189569 | Brett Finberg | Pharmacy Technician | 141 33rd Ave South, Saint Cloud, MN 56301 | 2017-04-26 |
| 1629513221 | Robert Schug | Pharmacy Technician | 141 33rd Ave S, Saint Cloud, MN 56301 | 2017-01-05 |
| 1649726910 | Rebecca Hoffman Pllc | Specialist | 3400 1st Street N, Suite 300, St. Cloud, MN 56301 | 2016-08-28 |
| 1558728600 | Language Partners | Interpreter | 400 1st St S, Suite 600, St. Cloud, MN 56301 | 2016-01-20 |
| 1679981856 | Quality Homecare Services Inc | Home Health | 3450 W Germain St, Ste 206, St Cloud, MN 56301 | 2014-07-31 |
| 1063759546 | Grand St Paul Cvs, LLC | Durable Medical Equipment & Medical Supplies | 2420 Division St, St. Cloud, MN 56301 | 2013-01-03 |
| Find all providers in zip 56301 | ||||
| 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 |
|---|---|---|---|---|
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1043721202 | Eye Doctors Optical Outlets, Pa | Eyewear Supplier (Equipment, not the service) | 140 E 13th St, Saint Cloud, FL 34769-4703 | 2017-10-16 |
| 1942408521 | Essilor Laboratories of America, Inc | Eyewear Supplier (Equipment, not the service) | 6650 Saukview Dr, Saint Cloud, MN 56303-0806 | 2007-07-05 |
| 1134327794 | Essilor Laboratories of America, Inc | Eyewear Supplier (Equipment, not the service) | 6925 Saukview Dr, Saint Cloud, MN 56303-0813 | 2007-07-05 |
| 1407051279 | Eye Kraft Optical, Inc | Eyewear Supplier (Equipment, not the service) | 8 Mcleland Rd, Saint Cloud, MN 56303-2049 | 2007-06-20 |
| 1659498210 | Wimmer Opticians Inc | Eyewear Supplier (Equipment, not the service) | 901 W Saint Germain St, Saint Cloud, MN 56301-3460 | 2007-03-26 |
| 1376635466 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 4165 W Division St, Ste C7, Saint Cloud, MN 56301-3740 | 2006-09-28 |
| 1912928839 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 4101 W Division St Ste 20, Saint Cloud, MN 56301-5015 | 2006-07-23 |
| 1740212331 | America's Best Contacts and Eyeglasses, Inc. | Eyewear Supplier (Equipment, not the service) | 4142 W Division St, Saint Cloud, MN 56301-3706 | 2006-07-06 |
| 1063465789 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 501 Highway 10 Se, Saint Cloud, MN 56304-1250 | 2006-05-17 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56301 |
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.