SHOPKO STORES OPERATING CO. LLC (NPI# 1174576854) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174576854 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 040 |
| Practice Address |
3025 Hamilton Blvd Sioux City IA 51104-2407 |
| Practice Telephone | 7122555869 |
| Mailing Telephone | 7122555869 |
| 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 |
|---|---|---|---|
| MEDICARE | 17696 | 01 | |
| MEDICARE | 28489 | 01 | |
| AVESIS | 35440 | 01 | |
| EYEMED | CP2230-9 | 01 | |
| VIP | 014040 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 040 | 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 |
3025 HAMILTON BLVD |
| City | SIOUX CITY |
| State | IA |
| Zip Code | 51104-2407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962453621 | David James Korver | Optometrist | 3025 Hamilton Blvd, Sioux City, IA 51104-2407 | 2006-05-15 |
| 1801148143 | Brittany J Krause | Optometrist | 3025 Hamilton Blvd, Sioux City, IA 51104-2407 | 2012-10-10 |
| 1407807118 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 3025 Hamilton Blvd, Sioux City, IA 51104-2407 | 2006-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578944435 | Family First Dental Associates of Iowa, P.C. | Dentist | 2100 Indian Hills Drive, Sioux City, IA 51104 | 2015-06-16 |
| 1740590785 | Khatu Vivienne Erlbacher | Pharmacist | 515 North Briar Path, Sioux City, IA 51104 | 2010-10-08 |
| 1730407545 | Randall Glen Wood | Emergency Medicine | 2720 Stone Park Blvd., Sioux City, IA 51104 | 2010-05-04 |
| 1790811024 | Fred R Rizk | Dentist | 1923 Nebraska Street, Siuox City, IA 51104 | 2007-02-23 |
| 1255474029 | Edilia Maria Marshall | Dentist | Summit Dental, 2114 Pierce St, Sioux City, IA 51104 | 2007-02-14 |
| 1063553410 | Thomas Leonard Tiedeman | Dentist | 2918 Hamilton Blvd, Upper D Suite 1, Sioux City, IA 51104 | 2007-02-09 |
| 1336209188 | Shawn Robert Walton | Dentist | 2410 Pierce Street, Sioux City, IA 51104 | 2006-12-11 |
| 1477649556 | Timothy R Kuntz | Dentist | 3012 Hamilton Blvd, Sioux City, IA 51104 | 2006-10-05 |
| 1528162732 | Duane Kent Nelson | Orthopaedic Surgery | 2800 Peirce St, Suite 101, Sioux City, IA 51104 | 2006-09-08 |
| 1659482206 | Shawn R Walton | Dentist | 2928 Hamilton Blvd, Suite 102, Sioux City, IA 51104 | 2006-08-31 |
| Find all providers in zip 51104 | ||||
| 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 |
|---|---|---|---|---|
| 1215593686 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2927 Hamilton Blvd, Sioux City, IA 51104-2405 | 2019-05-11 |
| 1326241233 | Pech Optical Corp | Eyewear Supplier (Equipment, not the service) | 2717 Murray St, Sioux City, IA 51111 | 2007-06-07 |
| 1467501981 | Tkc Optical | Eyewear Supplier (Equipment, not the service) | 431 Pierce St, Sioux City, IA 51101-1413 | 2007-01-10 |
| 1336205566 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 4480 Sergeant Rd, Sioux City, IA 51102-4703 | 2006-12-30 |
| 1619052602 | Vision World Inc | Eyewear Supplier (Equipment, not the service) | 4400 Sergeant Road, Sioux City, IA 51106 | 2006-10-26 |
| 1487101002 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 5775 Sunnybrook Dr, Sioux City, IA 51106-4247 | 2016-09-01 |
| 1730587882 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 5001 Sergeant Rd, Suite 45, Sioux City, IA 51106-4774 | 2014-12-05 |
| 1912176256 | John D. Kiernan Od | Eyewear Supplier (Equipment, not the service) | 1214 Pierce St, Sioux City, IA 51105-1417 | 2008-02-20 |
| 1326193012 | Tkc Optical, Inc | Eyewear Supplier (Equipment, not the service) | 2513 Hamilton Blvd, Sioux City, IA 51104-4045 | 2007-01-24 |
| 1972600138 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 4400 Sergeant Rd, Sioux City, IA 51106-4740 | 2006-09-20 |
| Find all providers in SIOUX CITY | ||||
| City | SIOUX CITY |
| Zip Code | 51104 |
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.