SHOPKO STORES OPERATING CO. LLC (NPI# 1235181298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235181298 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 042 |
| Practice Address |
1300 S Koeller St Oshkosh WI 54902-6169 |
| Practice Telephone | 9204265730 |
| Mailing Telephone | 9204265730 |
| 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 |
|---|---|---|---|
| VIP | 014042 | 01 | |
| EYEMED | CP2230-85 | 01 | |
| NVA | 410985054-4042 | 01 | |
| DAVIS | 42595 | 01 | |
| MEDICARE | 17653 | 01 | |
| AVESIS | 35722 | 01 | |
| WI | 38425700 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 042 | 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 |
1300 S KOELLER ST |
| City | OSHKOSH |
| State | WI |
| Zip Code | 54902-6169 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548691371 | Luke Mittelstaedt | Pharmacist | 1300 S Koeller St, Oshkosh, WI 54902-6169 | 2013-12-04 |
| 1194152108 | Dana Jon Kleveland | Pharmacist | 1300 S Koeller St, Oshkosh, WI 54902-6169 | 2013-10-04 |
| 1598105520 | Bruce D Rogers | Pharmacist | 1300 S Koeller St, Oshkosh, WI 54902-6169 | 2013-07-05 |
| 1962458315 | Shopko Stores Operating Co LLC | Pharmacy | 1300 S Koeller St, Oshkosh, WI 54902-6169 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528688363 | Grandpa Ray's Home Care Partners LLC | In Home Supportive Care | 1755 W 7th Avenue, Oshkosh, WI 54902 | 2020-04-22 |
| 1942866314 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1212 S Koeller St, Oshkosh, WI 54902 | 2019-05-11 |
| 1508299926 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1736 W. 9th Ave., Oshkosh, WI 54902 | 2013-08-21 |
| 1881971513 | Eric D Jachthuber | Pharmacist | 950 Koeller Rd, Oshkosh, WI 54902 | 2011-11-09 |
| 1912158148 | Jennifer L Daly | Registered Nurse | 648 West 5th Avenue, Oshkosh, WI 54902 | 2008-10-07 |
| 1093873028 | Phyllis Ann Pieplow | Registered Nurse | 2307 Doty St, Oshkosh, WI 54902 | 2006-12-04 |
| 1336210939 | Juliette P M Sterkens | Audiologist | 1820 West Pointe Drive, Fox Valley Hearing Ctr Inc, Oshkosh, WI 54902 | 2006-11-13 |
| 1043266927 | Christopher S. Mcfarlane | Dentist | 1875 West Pointe Dr., Oshkosh, WI 54902 | 2006-05-25 |
| 1285688192 | Theresa Lynn Petrick Gatchell | Optometrist | 1300 S Koeller Road, Oshkosh, WI 54902 | 2006-05-22 |
| 1558329821 | Teresa M Vanaacken | Physical Therapist | 300 S Koeller Street, Suite B, Oshkosh, WI 54902 | 2006-05-03 |
| Find all providers in zip 54902 | ||||
| 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 |
|---|---|---|---|---|
| 1942866314 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1212 S Koeller St, Oshkosh, WI 54902 | 2019-05-11 |
| 1871076968 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1810 Jackson St, Oshkosh, WI 54901-2204 | 2018-09-13 |
| 1174684534 | Stellar Vision Inc | Eyewear Supplier (Equipment, not the service) | 358 S Koeller St, Oshkosh, WI 54902-5546 | 2006-12-12 |
| 1801993977 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1098 S Koeller St, Koeller Ctr, Oshkosh, WI 54902-6172 | 2006-09-20 |
| 1083270490 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1810 Jackson St, Oshkosh, WI 54901-2204 | 2019-05-13 |
| 1598188930 | G F Jensen | Eyewear Supplier (Equipment, not the service) | 422 N Main St, Oshkosh, WI 54901-4924 | 2014-01-21 |
| 1972941599 | G F Jensen | Eyewear Supplier (Equipment, not the service) | 422 N Main St, Oshkosh, WI 54901-4924 | 2013-06-05 |
| 1043527773 | Pearle Vision Inc | Eyewear Supplier (Equipment, not the service) | 1098 S Koeller St, Koeller Ctr, Oshkosh, WI 54902-6172 | 2010-09-01 |
| 1992969083 | Oshkosh Optical Center S. C. | Eyewear Supplier (Equipment, not the service) | 511 W Murdock Ave, Oshkosh, WI 54901-2213 | 2008-07-17 |
| 1578617957 | Ophthalmic Surgery of Wi Ltd | Eyewear Supplier (Equipment, not the service) | 509 S Washburn St, Oshkosh, WI 54904 | 2007-01-22 |
| Find all providers in OSHKOSH | ||||
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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.