SHOPKO STORES OPERATING CO. LLC (NPI# 1437101698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437101698 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 082 |
| Practice Address |
5959 S State St Murray UT 84107-7222 |
| Practice Telephone | 8012611113 |
| Mailing Telephone | 8012611113 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-07-10 |
| 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 |
|---|---|---|---|
| UT | 410985054-084 | 05 | |
| MEIDCARE | 17916 | 01 | |
| UT | NORIDIAN SUBMITTER ID | UT04873 | 01 |
| VIP | 014082 | 01 | |
| DAVIS | 42539 | 01 | |
| EYEMED | CP2230-44 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 082 | 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 |
5959 S STATE ST |
| City | MURRAY |
| State | UT |
| Zip Code | 84107-7222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477504793 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 5959 S State St, Murray, UT 84107-7222 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410517 | Brielle Nicole Poulter | Student in an Organized Health Care Education/Training Program | 345 East 4500 So #260, Murray, UT 84107 | 2020-09-01 |
| 1467016592 | Ashlee Brown | Social Worker | C-134, 5284 Commerce Drive, Murray, Murray, UT 84107 | 2019-04-24 |
| 1568940633 | Samantha Duff | Occupational Therapist | 5770 S Fashion Blvd, Bldg 5 Ste 201, Murray, UT 84107 | 2018-08-01 |
| 1881185247 | Derek John Sharp | Occupational Therapist | 5770 S Fashion Blvd, Bldg #5, Suite 210, Murray, UT 84107 | 2018-05-22 |
| 1093223091 | Erin Nicole Hill | Counselor | 345 East 4500 South Suite 260, Murray, UT 84107 | 2018-01-12 |
| 1588171219 | Nicole Danielle Jensen | Counselor | 345 East 4500 South, Suite 260, Murray, UT 84107 | 2018-01-03 |
| 1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
| 1043739667 | Karyn K Hodge | Audiologist | 4500 So. 777. E. Ste #110, Murray, UT 84107 | 2017-09-14 |
| 1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
| 1396261152 | Megan Lehane Delano | Plastic Surgery | 5169 Cottonwood St Ste 420, Murray, UT 84107 | 2017-08-14 |
| Find all providers in zip 84107 | ||||
| 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 |
|---|---|---|---|---|
| 1790225696 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 6117 S State St, Murray, UT 84107-7343 | 2017-02-27 |
| 1669562054 | Visionworks Inc | Eyewear Supplier (Equipment, not the service) | 148 E Winchester St, Area C D, Murray, UT 84107-7211 | 2006-10-13 |
| 1568561975 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 6191 S State St # 1200, Murray, UT 84107 | 2006-09-22 |
| 1265907620 | Central Utah Clinic, P.C. | Eyewear Supplier (Equipment, not the service) | 5872 S 900 E Ste 100, Murray, UT 84121-1677 | 2018-10-11 |
| 1326439530 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 5201 S Intermountain Dr, Murray, UT 84107-6024 | 2015-02-10 |
| 1215283247 | Optical Land,llc | Eyewear Supplier (Equipment, not the service) | 153 E 4370 S, Suite 7, Murray, UT 84107 | 2012-07-27 |
| 1144533506 | Cole Vision Corporation | Eyewear Supplier (Equipment, not the service) | 6191 S State St, Murray, UT 84107-7258 | 2010-07-14 |
| 1720237951 | Clearview Optical Inc | Eyewear Supplier (Equipment, not the service) | 201 E 5900 S, Suite 101, Murray, UT 84107-5428 | 2008-09-11 |
| 1023175288 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 6191 S State St, Murray, UT 84107-7258 | 2007-01-03 |
| 1285797282 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 228 E 6400 S, Murray, UT 84107-7305 | 2006-12-19 |
| Find all providers in MURRAY | ||||
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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.