SHOPKO STORES OPERATING CO. LLC


Address: 1845 Haines Ave, Rapid City, SD 57701-0663
Phone: 6053420354

SHOPKO STORES OPERATING CO. LLC (NPI# 1306899174) 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) 1306899174
Entity Type Organization
Organization Name SHOPKO STORES OPERATING CO. LLC
Other Organization Name SHOPKO OPTICAL 078
Practice Address 1845 Haines Ave
Rapid City
SD 57701-0663
Practice Telephone 6053420354
Mailing Telephone 6053420354
Enumeration Date 2006-05-19
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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 332H00000X Eyewear Supplier (Equipment, not the service) Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
AVESIS 35518 01
EYEMED CP2230-37 01
MEDICARE 17914 01
VIP 014078 01

Other Provider/Organization Names

Other Name Type Code
ShopKo Optical 078 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 1845 HAINES AVE
City RAPID CITY
State SD
Zip Code 57701-0663

Providers in the same location

NPI Name Taxonomy Address Enumeration
1952352544 Shopko Stores Operating Co LLC Durable Medical Equipment & Medical Supplies 1845 Haines Ave, Rapid City, SD 57701-0663 2006-05-16
1699728766 Greg Sorensen Optometrist 1845 Haines Ave, Rapid City, SD 57701-0663 2006-05-18

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1528623345 Julie Maas Counselor 625 1/2 Main St, Suite 1, Rapid City, SD 57701 2019-05-07
1972076024 Edgewood Rapid City LLC Assisted Living Facility 4001 Derby Lane, Rapid City, SD 57701 2019-01-10
1902300247 Theresa Gibbens Speech-Language Pathologist 3301 Grandview Drive, Rapid City, SD 57701 2018-03-21
1407355423 Arielle Leigh Loveridge Chiropractor 610 East Boulevard, Suite 1, Rapid City, SD 57701 2018-02-05
1083125082 Sarah Kirschman Nurse Practitioner 353 Fairmont Boulvevard, Rapid City, SD 57701 2017-10-17
1992225239 Kelsey Elizabeth Wondercheck Dentist 717 Meade Street, Suite 200, Rapid City, SD 57701 2017-06-27
1316476088 Rhianna Wickett Physical Therapist 420 E Saint Patrick St Ste 101, Rapid City, SD 57701 2017-06-07
1841727773 Cynthia A Gates Dietitian, Registered 2908 5th Street, Rapid City, SD 57701 2017-05-23
1811447758 Alyssa Marquardt Psychologist 433 Mt. Rushmore Road, Rapid City, SD 57701 2016-10-04
1578913232 .indian Health Service Clinic/Center 241 East Meade St, Rapid City, SD 57701 2016-06-14
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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
1427249721 Essilor Laboratories of America, Inc Eyewear Supplier (Equipment, not the service) 109 New York St, Rapid City, SD 57701-1154 2007-08-05
1760589774 Luxottica Retail North America Inc Eyewear Supplier (Equipment, not the service) 2200 N Maple, Rushmore Mall, Rapid City, SD 57701-7854 2006-09-20
1942217674 Usv Optical Inc. Eyewear Supplier (Equipment, not the service) 2200 N. Maple Avenue, Rapid City, SD 57701 2006-08-02
1043259930 Independent Optical, Inc Eyewear Supplier (Equipment, not the service) 810 Mount Rushmore Rd, Rapid City, SD 57701-3603 2006-06-06
1205874252 National Vision, Inc. Eyewear Supplier (Equipment, not the service) 1200 N Lacrosse St, Rapid City, SD 57701-6984 2006-06-03
1194123158 Eyemart Express LLC Eyewear Supplier (Equipment, not the service) 1605 Eglin St, Rapid City, SD 57701-6107 2014-12-08
1437555182 Pillen Optical Inc Eyewear Supplier (Equipment, not the service) 409 Kansas City St, Rapid City, SD 57701-8239 2014-11-07
1659509107 Eyemart Express Ltd Eyewear Supplier (Equipment, not the service) 1605 Eglin St, Rapid City, SD 57701-6107 2009-06-23
1487797320 Your Eyes Only Optical, Inc Eyewear Supplier (Equipment, not the service) 240 Minnesota St, Rapid City, SD 57701-6200 2007-02-14

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1457989006 Shoptikal LLC Eyewear Supplier (Equipment, not the service) 3330 E 10th St, Sioux Falls, SD 57103-2107 2020-03-30
1013573484 Shoptikal LLC Eyewear Supplier (Equipment, not the service) 1519 9th Ave Se Ste A, Watertown, SD 57201-3960 2019-05-11
1588220958 Shoptikal LLC Eyewear Supplier (Equipment, not the service) 3307 7th Ave Se Ste 105, Aberdeen, SD 57401-6613 2019-05-11
1780082628 Eyemart Express LLC Eyewear Supplier (Equipment, not the service) 3501 W 41st St Ste A, Sioux Falls, SD 57106-0799 2014-12-09
1215292560 Eagle Vision Eyewear Supplier (Equipment, not the service) 906 1/2 9th Ave Se, Watertown, SD 57201 2012-07-11
1346508348 Sunland Optical Co., Inc. Eyewear Supplier (Equipment, not the service) 2725 Lemay Blvd, Ellsworth Afb, SD 57706-4868 2012-04-26
1679850291 Visionworks, Inc. Eyewear Supplier (Equipment, not the service) 850 W Empire Mall, Sioux Falls, SD 57106-6512 2011-11-10
1881911964 Cole Vision Corporation Eyewear Supplier (Equipment, not the service) 3400 Empire Mall, Sioux Falls, SD 57106-0720 2010-04-28
1306016407 Lg Optical Enterprises Eyewear Supplier (Equipment, not the service) 952 22nd Ave S, Brookings, SD 57006-2830 2008-03-04
1518158815 Essilor Laboratories of America, Inc Eyewear Supplier (Equipment, not the service) 3109 W 41st St Ste 115, Sioux Falls, SD 57105-8142 2007-08-05
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City RAPID CITY
Zip Code 57701

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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