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).
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 |
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 |
---|---|---|---|
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 Name | Type Code |
---|---|
ShopKo Optical 169 | 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 |
3499 E FAIRVIEW AVE |
City | MERIDIAN |
State | ID |
Zip Code | 83642-5848 |
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 |
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 |
Find all providers in zip 83642 |
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 |
---|---|---|---|---|
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 |
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 |
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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.