SHOPKO STORES OPERATING CO. LLC (NPI# 1174576748) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174576748 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 075 |
| Practice Address |
2510 S Reserve St Missoula MT 59801-7546 |
| Practice Telephone | 4067214646 |
| Mailing Telephone | 4067214646 |
| Enumeration Date | 2006-05-18 |
| 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 |
|---|---|---|---|
| VIP | 014075 | 01 | |
| AVESIS | 35494 | 01 | |
| MEDICARE | 17878 | 01 | |
| EYEMED | 213121-21 | 01 | |
| MT | 0550862 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 075 | 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 |
2510 S RESERVE ST |
| City | MISSOULA |
| State | MT |
| Zip Code | 59801-7546 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205819638 | Rebecca Katherine Pitt Jackson | Optometrist | 2510 S Reserve St, Missoula, MT 59801-7546 | 2005-11-21 |
| 1245632744 | Gretchen Dierken | Pharmacist | 2510 S Reserve St, Missoula, MT 59801-7546 | 2014-09-16 |
| 1427450980 | Brett Currie | Pharmacist | 2510 S Reserve St, Missoula, MT 59801-7546 | 2014-09-16 |
| 1043259104 | Thomas R Ferguson | Optometrist | 2510 S Reserve St, Missoula, MT 59801-7546 | 2006-06-05 |
| 1215981014 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2510 S Reserve St, Missoula, MT 59801-7546 | 2006-05-19 |
| 1679534705 | Gregory Gene Zell | Optometrist | 2510 S Reserve St, Missoula, MT 59801-7546 | 2006-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681010 | Time To Thrive Pllc | Social Worker | 1836 South Ave. West, Missoula, MT 59801 | 2020-08-26 |
| 1740815653 | Yuzo Fujiki | Specialist/Technologist | 210 N California St 104, Missoula, MT 59801 | 2020-03-11 |
| 1407346596 | Stepping Stones Counseling, Pllc | Counselor | 202 Brooks St Ste 300, Missoula, MT 59801 | 2018-05-14 |
| 1437668530 | Rejuve Care Clinic, Inc | Plastic Surgery | 715 Kensingten, Ste 1, Missoula, Missoula, MT 59801 | 2017-09-21 |
| 1619499555 | Beatrice Elise Powers | Specialist/Technologist | 410 B Stephens Ave, Missoula, MT 59801 | 2017-07-12 |
| 1770012197 | Hannah Lepiane | Massage Therapist | 1313 S. 4th W., Missoula, MT 59801 | 2017-06-08 |
| 1811420227 | Celeste Willis | Social Worker | 1055 W. Sussex, Missoula, MT 59801 | 2017-04-04 |
| 1073050498 | Rina Kasuga | Specialist/Technologist | 913 Rimini Ct, Missoula, MT 59801 | 2017-01-24 |
| 1043756919 | Heather Bartz | Specialist/Technologist | 831 Hastings Ave, Missoula, MT 59801 | 2017-01-16 |
| 1255874517 | Sarabeth Haddad | Social Worker | 1055 W Sussex Ave, Missoula, MT 59801 | 2016-11-18 |
| Find all providers in zip 59801 | ||||
| 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 |
|---|---|---|---|---|
| 1225684020 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1715 S Reserve St, Missoula, MT 59801-4705 | 2019-08-16 |
| 1497949002 | Specticca Inc | Eyewear Supplier (Equipment, not the service) | 319 N Higgins Ave, Missoula, MT 59802-4537 | 2007-08-28 |
| 1215051396 | Walman Optical Company | Eyewear Supplier (Equipment, not the service) | 1245 S 3rd St W, Missoula, MT 59801-2333 | 2007-03-16 |
| 1427062702 | Us Vision Optical Inc | Eyewear Supplier (Equipment, not the service) | Southgate Mall, Missoula, MT 59801 | 2006-07-29 |
| 1568830685 | Bulls Eye Wear Ltd. Co. | Eyewear Supplier (Equipment, not the service) | 2910 S Reserve St, Missoula, MT 59801-7676 | 2015-09-05 |
| 1003207234 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 3220 N Reserve St, Missoula, MT 59808-1556 | 2015-02-10 |
| 1932383627 | Michael Simons P.C. | Eyewear Supplier (Equipment, not the service) | 726 Kensington Ave, Missoula, MT 59801-5720 | 2007-12-18 |
| 1336294404 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 2901 Brooks St, Southgate Mall, Missoula, MT 59801-7722 | 2007-01-25 |
| 1497702989 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 4000 Us Highway 93 S, Missoula, MT 59804-7347 | 2006-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780061960 | Usv Optical Inc | Eyewear Supplier (Equipment, not the service) | 7200 Perimeter Rd., Bldg 1340, Malmstrom Afb, MT 59402 | 2015-04-27 |
| 1285992255 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 7200 Perimeter Road, Building 1340, Great Falls, MT 59402-6856 | 2012-04-27 |
| 1104101211 | Quality Vision Care | Eyewear Supplier (Equipment, not the service) | 1040 Partridge Pl Ste 10, Helena, MT 59602-0518 | 2011-10-20 |
| 1881924413 | Sam's Club Optical | Eyewear Supplier (Equipment, not the service) | 4420 King Avenue East, Billings, MT 59101 | 2010-01-04 |
| 1831382605 | Jeffrey D. Heninger, O.d. Pllc | Eyewear Supplier (Equipment, not the service) | 203a Ridgewater Dr, Polson, MT 59860-8992 | 2007-08-24 |
| 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 |
| 1699965681 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2825 W Main, Gallatin Valley Mall #5d, Bozeman, MT 59718-3927 | 2007-07-26 |
| 1366654840 | Big Sky Optical | Eyewear Supplier (Equipment, not the service) | 14 South Montana, Butte, MT 59701-0000 | 2007-05-04 |
| 1568685790 | Pearle Vision | Eyewear Supplier (Equipment, not the service) | 20 N Main St Ste B13, Kalispell, MT 59901-4080 | 2007-04-10 |
| 1477677623 | Walman Optical Company | Eyewear Supplier (Equipment, not the service) | 410 Central Avenue, 320 Strain Building, Great Falls, MT 59401 | 2007-03-16 |
| Find all providers with the same taxonomy | ||||
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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.