SHOPKO STORES OPERATING CO. LLC (NPI# 1336191501) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336191501 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 053 |
| Practice Address |
510 E Philip Ave North Platte NE 69101-5538 |
| Practice Telephone | 3085347271 |
| Mailing Telephone | 3085347271 |
| Enumeration Date | 2006-05-16 |
| 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 |
|---|---|---|---|
| BLOCK | 007127 | 01 | |
| DAVIS | 35865 | 01 | |
| VIP | 014053 | 01 | |
| MEDICARE | 096219 | 01 | |
| AVESIS | 35502 | 01 | |
| MEDICARE | 17889 | 01 | |
| EYEMED | CP2230-29 | 01 | |
| NE | 41098505403 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 053 | 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 |
510 E PHILIP AVE |
| City | NORTH PLATTE |
| State | NE |
| Zip Code | 69101-5538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992756084 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 510 E Philip Ave, North Platte, NE 69101-5538 | 2006-05-13 |
| 1295264547 | Kelly Mccarthy | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2017-06-09 |
| 1184976425 | Karl Thomas Jepson | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2012-10-10 |
| 1235275983 | Jason L Hawley | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2007-01-29 |
| 1922045616 | John L Dorwart | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972017523 | Rocky Mountain Holdings, LLC | Ambulance | 5570 E. Lee Bird Drive, Northe Platte, NE 69101 | 2017-11-18 |
| 1396297503 | Karen L Gutherless | Counselor | 401 W Walker Road, North Platte, NE 69101 | 2016-11-04 |
| 1992165898 | Laren Alden Roper Jr. | Occupational Therapist | 1115 S Cottonwood, Great Plains Sports and Therapy Center, North Platte, NE 69101 | 2016-03-04 |
| 1669733085 | Stephanie Lynn Marcy | Anesthesiology | 601 W Leota Street, Anes: Anesthesiology, North Platte, NE 69101 | 2012-06-01 |
| 1033480470 | Wb Counseling LLC | Counselor | 319 E. B St., North Platte, NE 69101 | 2012-01-17 |
| 1306114962 | Amy J Kloess | Occupational Therapist | 8165 North Twin Lakes Rd, North Platte, NE 69101 | 2011-12-09 |
| 1043442312 | Derek Walrod | Dentist | 1225 South Poplar, Suite 500, North Platte, NE 69101 | 2009-08-20 |
| 1033374525 | Millie Erickson | Urology | 611 W. Francis St., Suite 200, North Platte, NE 69101 | 2008-07-23 |
| 1952586331 | West Central District Health Department | Public Health or Welfare | 111 North Dewey Street, North Platte, NE 69101 | 2008-01-04 |
| 1558579698 | Piper Dental Clinic | Dentist | 1919 West A Street, North Platte, NE 69101 | 2007-05-21 |
| Find all providers in zip 69101 | ||||
| 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 |
|---|---|---|---|---|
| 1992986467 | North Platte Vision Center, LLC | Eyewear Supplier (Equipment, not the service) | 402 S Dewey St, North Platte, NE 69101-5423 | 2007-11-26 |
| 1649365974 | Mark R Young M.d.p.c. | Eyewear Supplier (Equipment, not the service) | 1214 West A Street, North Platte, NE 69101 | 2006-10-03 |
| 1265887160 | Eye Care Professionals, LLC | Eyewear Supplier (Equipment, not the service) | 810 W Reid Ave, Suite #2, North Platte, NE 69101-6582 | 2016-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003462763 | Thundercloud Optical, LLC | Eyewear Supplier (Equipment, not the service) | 8838 Washington Cir, Omaha, NE 68127-4011 | 2019-08-16 |
| 1841856234 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2801 Pine Lake Rd Ste J, Lincoln, NE 68516-6041 | 2019-05-12 |
| 1659937027 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2802 S 143rd Plz, Omaha, NE 68144-5611 | 2019-05-11 |
| 1902462377 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1130 S 13th St Ste 200, Norfolk, NE 68701-5733 | 2019-05-11 |
| 1952967325 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1919 N Diers Ave Ste B, Grand Island, NE 68803-1284 | 2019-05-11 |
| 1760048136 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 848 Cornhusker Rd Ste 105, Bellevue, NE 68123-4433 | 2019-05-11 |
| 1578099024 | Walman Optical Company | Eyewear Supplier (Equipment, not the service) | 12240 Emmet St, Omaha, NE 68164-4265 | 2017-05-03 |
| 1679921720 | Statton Optical | Eyewear Supplier (Equipment, not the service) | 4645 Normal Blvd Ste 132, Lincoln, NE 68506-5823 | 2016-05-31 |
| 1477890937 | Arkfeld, Parson, Goldstein, PC | Eyewear Supplier (Equipment, not the service) | 450 Regency Pkwy, Suite 110, Omaha, NE 68114-3764 | 2013-01-03 |
| 1588950869 | Sutton Vision Center Inc | Eyewear Supplier (Equipment, not the service) | 103 N Saunders Ave, Sutton, NE 68979-2506 | 2011-06-24 |
| Find all providers with the same taxonomy | ||||
| City | NORTH PLATTE |
| Zip Code | 69101 |
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO. LLC.
| 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.