SHOPKO STORES OPERATING CO. LLC (NPI# 1205888344) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205888344 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 003 |
| Practice Address |
3415 Calumet Ave Manitowoc WI 54220-5427 |
| Practice Telephone | 9206832244 |
| Mailing Telephone | 9206832244 |
| 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 |
|---|---|---|---|
| NVA | 410985054-4003 | 01 | |
| VIP | 014003 | 01 | |
| MEDICARE | 13861 | 01 | |
| DAVIS | 42509 | 01 | |
| WI | 38417800 | 05 | |
| EYEMED | CP2230-79 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 003 | 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 |
3415 CALUMET AVE |
| City | MANITOWOC |
| State | WI |
| Zip Code | 54220-5427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760812747 | Jeffrey Pritzl | Pharmacist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2013-11-12 |
| 1821439415 | Melissa A Klein | Pharmacist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2013-07-10 |
| 1295171221 | Paul Robert Gray | Pharmacist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2013-05-16 |
| 1689928483 | Debra Ann St.pierre | Pharmacist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2012-10-31 |
| 1538340468 | Sheri L Mcglone | Hearing Instrument Specialist | 3415 Calumet Ave, Exela Hearing Services, Manitowoc, WI 54220-5427 | 2007-11-20 |
| 1992878730 | Bellin Memorial Hospital Inc | Family Medicine | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2006-11-17 |
| 1205875655 | Donald James Domrath | Optometrist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2006-06-04 |
| 1982659157 | Shopko Stores Operating Co LLC | Pharmacy | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2006-05-24 |
| 1346294741 | Ronald Demark | Optometrist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2006-05-20 |
| 1316991698 | Brian F Cook | Optometrist | 3415 Calumet Ave, Manitowoc, WI 54220-5427 | 2006-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235614843 | Katherine Borchardt | Registered Nurse | 3520 Foxfire Ct, Manitowoc, WI 54220 | 2018-09-28 |
| 1285128215 | Aurora Pharmacy Inc | Pharmacy | 3509 Dewey Street, Suite 100, Manitowoc, WI 54220 | 2018-06-22 |
| 1477937274 | Baycare Clinic LLP | Psychiatry & Neurology | 4801 Expo Drive, Manitowoc, WI 54220 | 2015-07-13 |
| 1831593821 | Brittany Camille Schultz | Acupuncturist | 2510 Washington Street, Manitowoc, WI 54220 | 2014-10-20 |
| 1710311261 | Brian E Weitz | Physical Therapy Assistant | 960 S. Rapids Rd., Manitowoc, WI 54220 | 2013-09-01 |
| 1134499080 | Total Renal Care Inc | Clinic/Center | 3303 Dewey St, Manitowoc, WI 54220 | 2012-01-10 |
| 1679858534 | Lisa M Noworatzky | Marriage & Family Therapist | 926 S. 8th St., Manitowoc, WI 54220 | 2011-10-11 |
| 1306177225 | Cynthia Fay Wenzel | Licensed Practical Nurse | 915 East Linden Avenue, Manitowoc, WI 54220 | 2010-01-15 |
| 1851550628 | Roundys Supermarkets Inc | Pharmacy | 3300 Calumet Ave, Manitowoc, WI 54220 | 2008-06-05 |
| 1851566079 | Jennifer C Mcwilliams | Registered Nurse | 1004 Nth 8th St., Manitowoc, WI 54220 | 2008-04-29 |
| Find all providers in zip 54220 | ||||
| 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 |
|---|---|---|---|---|
| 1912563412 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4530 Calumet Ave Ste 103, Manitowoc, WI 54220-9346 | 2019-05-10 |
| 1730657289 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 4140 Harbor Town Ln, Manitowoc, WI 54220-5851 | 2018-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658772 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1073 E Johnson St, Fond Du Lac, WI 54935-8919 | 2020-10-27 |
| 1578170247 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 120 N Grand Ave Ste 102, Sun Prairie, WI 53590-9007 | 2020-09-28 |
| 1639784622 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2268 W Mason St, Green Bay, WI 54303-4707 | 2020-09-15 |
| 1427669746 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1607 Losey Blvd S, La Crosse, WI 54601-6151 | 2020-08-11 |
| 1710598032 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 631 Hometown Cir Ste 106, Verona, WI 53593-1561 | 2020-08-11 |
| 1871138073 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 723 Main Ave, Depere, WI 54115 | 2019-11-12 |
| 1558903815 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 422 Gammon Pl, Madison, WI 53719-1026 | 2019-10-08 |
| 1669013256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 123 N Mall Dr, Grand Chute, WI 54913-8531 | 2019-10-04 |
| 1952962763 | Martell Eyecare, LLC | Eyewear Supplier (Equipment, not the service) | 703 Third Street, Marathon, WI 54448 | 2019-06-23 |
| 1932767316 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1440 Capital Drive, Suite B, Pewaukee, WI 53072 | 2019-05-31 |
| 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.