SHOPKO STORES OPERATING CO. LLC


Address: 3499 E Fairview Ave, Meridian, ID 83642-5848
Phone: 2088841362

SHOPKO STORES OPERATING CO. LLC (NPI# 1184677759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1184677759
Entity Type Organization
Organization Name SHOPKO STORES OPERATING CO. LLC
Other Organization Name SHOPKO OPTICAL 169
Practice Address 3499 E Fairview Ave
Meridian
ID 83642-5848
Practice Telephone 2088841362
Mailing Telephone 2088841362
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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
ID 806430108 05
EYEMED CP2230-11 01
AVESIS 35448 01
VIP 014169 01
MEDICARE 1593902 01
MEDICARE 17840 01
DAVIS VISION 42568 01
ID 805542700 05

Other Provider/Organization Names

Other Name Type Code
ShopKo Optical 169 Doing Business As Name - Organization

Other Provider IDs and Locations

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

Other Data Sources

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

Office Location

Street Address 3499 E FAIRVIEW AVE
City MERIDIAN
State ID
Zip Code 83642-5848

Providers in the same location

NPI Name Taxonomy Address Enumeration
1356393623 David J Slagowski Optometrist 3499 E Fairview Ave, Meridian, ID 83642-5848 2006-05-16
1154989440 Tyler Callahan Pharmacy Technician 3499 E Fairview Ave, Meridian, ID 83642-5848 2019-05-31
1760940084 Akos Live, LLC Family Medicine 3499 E Fairview Ave, Meridian, ID 83642-5848 2019-03-05
1275010357 Albertsons LLC Pharmacy 3499 E Fairview Ave, Meridian, ID 83642-5848 2018-07-23
1073864021 Janette M Beckwith Pharmacist 3499 E Fairview Ave, Meridian, ID 83642-5848 2012-09-29
1225326325 Kelly Lynn Hancock Pharmacist 3499 E Fairview Ave, Meridian, ID 83642-5848 2011-07-11
1841421617 Flushot4you Clinical Medical Laboratory 3499 E Fairview Ave, Meridian, ID 83642-5848 2009-07-28
1235176983 Shopko Stores Operating Co LLC Durable Medical Equipment & Medical Supplies 3499 E Fairview Ave, Meridian, ID 83642-5848 2006-06-01

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1174145684 Ikdo South Meridian LLC Dentist 3839 E Amity Rd, Meridian, ID 83642 2020-05-07
1073133328 Prescription Pad LLC Pharmacy 885 S Vanguard Way, Meridian, ID 83642 2020-04-16
1609412683 Meridian Advanced Psychiatry, LLC Psychiatry & Neurology 1672 S Woodsage Ave., Meridan, ID 83642 2019-11-25
1194378927 Sergey Tsema Occupational Therapist 1259 E Pisa St, Meridian, ID 83642 2019-07-21
1003478629 Chris R Jackson Dentist Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 2019-07-03
1285293118 Morgan Family Medicine Nurse Practitioner 1660 S Woodsage Avenue, Meridian, ID 83642 2019-06-13
1033772793 Nugen Healthcare, Pllc Registered Nurse 2177 S Spoonbill Ave, Meridian, ID 83642 2019-04-18
1811471790 Courtney Crossland Physician Assistant 4949 S Hillsdale Ave., Meridian, ID 83642 2018-09-18
1841771938 Katelyn Perry Counselor 2068 S. Eagle Rd., Meridian, ID 83642 2018-08-27
1114406204 Gem Prep: Meridian LLC Case Management 2750 E.gala Ct., Meridian, ID 83642 2018-08-09
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Taxonomy Information

Taxonomy Code 332H00000X
Grouping Suppliers
Classification Eyewear Supplier (Equipment, not the service)

Taxonomy Definition

An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306478359 K&r Optical Solutions Corporation Eyewear Supplier (Equipment, not the service) 3126 8th St., Suite A, Meridian, MS 39301 2020-02-07
1518119585 Evans Optical LLC Eyewear Supplier (Equipment, not the service) 2024 15th St Ste 5d, Meridian, MS 39301-4130 2008-10-21
1891972048 Ellis Optical Shoppe Eyewear Supplier (Equipment, not the service) 2302 12th St, Meridian, MS 39301-3933 2008-01-29
1891842175 Luxottica Retail North America Inc Eyewear Supplier (Equipment, not the service) 1000 Bonita Lakes Cir, Bonita Lakes Mall, Meridian, MS 39301-6972 2007-01-05
1669090106 Costco Wholesale Corporation Eyewear Supplier (Equipment, not the service) 3403 W Chinden Blvd, Meridian, ID 83646-7151 2020-07-10

Providers in the same taxonomy and state

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
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Competitor

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City MERIDIAN
Zip Code 83642

Improve Information

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Dataset Information

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.

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