SHOPKO STORES OPERATING CO. LLC (NPI# 1386696383) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386696383 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 122 |
| Practice Address |
1340 N Wenatchee Ave Wenatchee WA 98801-1558 |
| Practice Telephone | 5096638868 |
| Mailing Telephone | 5096638868 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-06-05 |
| 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 | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| 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 |
|---|---|---|---|
| MEDICARE | G8855121 | 01 | |
| WA | 2016731 | 05 | |
| AVESIS | 35552 | 01 | |
| WA | NORIDIAN SUBMITTER ID | WA09230 | 01 |
| VIP | 014122 | 01 | |
| EYEMED | CP2230-60 | 01 | |
| MEDICARE | 17677 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 122 | 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 |
1340 N WENATCHEE AVE |
| City | WENATCHEE |
| State | WA |
| Zip Code | 98801-1558 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144760794 | Travis Iksic | Pharmacist | 1340 N Wenatchee Ave, Wenatchee, WA 98801-1558 | 2017-03-01 |
| 1285982736 | Donna Marie Mellison | Pharmacist | 1340 N Wenatchee Ave, Wenatchee, WA 98801-1558 | 2012-08-15 |
| 1275815359 | Allison Zimmer | Optometrist | 1340 N Wenatchee Ave, Wenatchee, WA 98801 | 2011-09-14 |
| 1871533208 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1340 N Wenatchee Ave, Wenatchee, WA 98801-1558 | 2006-06-07 |
| 1740232669 | Glenn H Isaacson | Optometrist | 1340 N Wenatchee Ave, Wenatchee, WA 98801-1558 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033728365 | Jeannie Jones | Massage Therapist | 15 2nd St, Hallway 15, Wenatchee, WA 98801 | 2020-07-22 |
| 1184246688 | Mireya Ann Bahena | Case Manager/Care Coordinator | Catholic Charities of The Diocese of 145 S. Worthen St., Wenatchee, WA 98801 | 2020-05-07 |
| 1871067843 | Bfg Wenatchee Propco Iv, LLC | Assisted Living Facility | 817 Red Apple Rd, Wenatchee, WA 98801 | 2019-01-14 |
| 1982177283 | Michael Lee Miller | Behavioral Analyst | 264 N. Mission, Wenatchee, WA 98801 | 2019-01-09 |
| 1972073526 | Daniel Jentges | Family Medicine | 413 N Mission St., Wenatchee, WA 98801 | 2018-11-27 |
| 1972010437 | Daniel Nickel | Occupational Therapy Assistant | 217 Wetherald St, Wenatchee, WA 98801 | 2018-01-05 |
| 1962916379 | The Professional Denture Center | Denturist | 533 South Mission St, Wenatchee, WA 98801 | 2017-11-21 |
| 1467978155 | Matthew Jerauld Laws | Massage Therapist | 416 Ninth Street, Wenatchee, WA 98801 | 2017-08-15 |
| 1073051363 | Kimberley Rae Chambers | Massage Therapist | 25 N Wenatchee Ave Suite 104, Wenatchee, WA 98801 | 2017-02-07 |
| 1841746187 | Valentina Alvarez | Counselor | 145 S Worthern, Wenatchee, WA 98801 | 2016-08-28 |
| Find all providers in zip 98801 | ||||
| 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 |
|---|---|---|---|---|
| 1235795626 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1052 Springwater Ave, Wenatchee, WA 98801-1546 | 2019-05-12 |
| 1962443358 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 2000 N Wenatchee Ave, Wenatchee, WA 98801-1056 | 2006-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004477 | The Vancouver Clinic Inc Ps | Eyewear Supplier (Equipment, not the service) | 2 S 56th Pl Ste 205, Ridgefield, WA 98642-3427 | 2020-05-15 |
| 1619514825 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 11111 Ne 8th St Ste 147, Bellevue, WA 98004-4489 | 2019-12-06 |
| 1790341675 | Zachary Robert Cooper | Eyewear Supplier (Equipment, not the service) | 301 Queen Anne Ave N # 506, Seattle, WA 98109-4513 | 2019-05-15 |
| 1154987535 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 9326 N Division St, Spokane, WA 99218-1227 | 2019-05-11 |
| 1699331074 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2529 Main St Ste P6-a, Union Gap, WA 98903-1690 | 2019-05-11 |
| 1972096584 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 15319 E Indiana Ave Ste 2, Spokane Valley, WA 99216 | 2018-06-08 |
| 1437648508 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 4502 S Steele St Ste 700, Tacoma, WA 98409-7224 | 2018-05-04 |
| 1407359151 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 9801 204th Ave E, Bonney Lake, WA 98391 | 2018-03-08 |
| 1457860702 | Visionpros Usa Inc | Eyewear Supplier (Equipment, not the service) | 1750 Grant Ave, Blaine, WA 98230-5155 | 2017-09-28 |
| 1982121075 | Jand Inc. | Eyewear Supplier (Equipment, not the service) | 3501 Fremont Ave N, Seattle, WA 98103-8813 | 2017-08-29 |
| 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.