SHOPKO STORES OPERATING CO. LLC (NPI# 1457303455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457303455 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 019 |
| Practice Address |
701 S Church St Watertown WI 53094-6213 |
| Practice Telephone | 9202619225 |
| Mailing Telephone | 9202619225 |
| 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 |
|---|---|---|---|
| EYEMED | CP2230-92 | 01 | |
| MEDICARE | 17643 | 01 | |
| VIP | 014019 | 01 | |
| WI | 38413000 | 05 | |
| NVA | 410985054-4019 | 01 | |
| DAVIS | 42606 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 019 | 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 |
701 S CHURCH ST |
| City | WATERTOWN |
| State | WI |
| Zip Code | 53094-6213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003866682 | Chris J Coffini | Optometrist | 701 S Church St, Watertown, WI 53094-6213 | 2006-05-12 |
| 1134502982 | Kellye Zaporski | Optometrist | 701 S Church St, Watertown, WI 53094-6213 | 2015-06-29 |
| 1851782353 | Lisa Brauer | Pharmacist | 701 S Church St, Watertown, WI 53094-6213 | 2015-02-05 |
| 1033540026 | Jody Nordby | Pharmacist | 701 S Church St, Watertown, WI 53094-6213 | 2013-12-02 |
| 1437595592 | Jennifer Lynn Reithmeyer | Pharmacist | 701 S Church St, Watertown, WI 53094-6213 | 2013-05-16 |
| 1124341375 | Alicja Janina Fitzgerald | Optometrist | 701 S Church St, Watertown, WI 53094-6213 | 2010-03-02 |
| 1245489897 | Watertown Regional Medical Center, Inc | Nurse Practitioner | 701 S Church St, Watertown, WI 53094-6213 | 2008-09-18 |
| 1235184953 | Shopko Stores Operating Co LLC | Pharmacy | 701 S Church St, Watertown, WI 53094-6213 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861025371 | Addie Marie Littrell | Pharmacist | 624 S Church Street, Pharmacy Department, Watertown, WI 53094 | 2020-02-13 |
| 1144788274 | Robert Scott Johnson | Dentist | 314 W. Main St., Watertown, WI 53094 | 2019-03-07 |
| 1043785264 | Christian Long | Physical Therapist | Watertown Regional Medical Center, 1684 S Church St, Watertown, WI 53094 | 2018-10-04 |
| 1558566497 | Georgia E Meyer | Occupational Therapist | Rahab In Motion, 615 East Main St Suite B, Watertown, WI 53094 | 2007-06-20 |
| 1588789036 | Kjm Enterprises Inc | Home Health | 111 N Third Street, Watertown, WI 53094 | 2007-03-20 |
| 1114085412 | Paul R Sommers Dds Sc | Dentist | 121 Oakridge Court, Watertown, WI 53094 | 2006-12-05 |
| 1063593614 | Stein Optical Inc | Eyewear Supplier (Equipment, not the service) | 622 S Church St, Watertown, WI 53094 | 2006-10-18 |
| 1598851800 | David J Groh | Dentist | 1521 Doctors Ct, Watertown, WI 53094 | 2006-10-05 |
| 1861594251 | Robert Delano Heinen | General Practice | 700 Hoffmann Dr, Bethesda Lutheran Homes and Services, Watertown, WI 53094 | 2006-09-05 |
| 1669483897 | Donald Alan Wollheim | Surgery | 1911 Gateway Drive, Watertown, WI 53094 | 2006-08-11 |
| Find all providers in zip 53094 | ||||
| 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 |
|---|---|---|---|---|
| 1013553437 | Jody Allen Shuler | Eyewear Supplier (Equipment, not the service) | 11 Public Sq Ste 102, Watertown, NY 13601-2698 | 2019-11-20 |
| 1265098628 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1500 S Church St, Watertown, WI 53094-6404 | 2019-05-11 |
| 1013573484 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1519 9th Ave Se Ste A, Watertown, SD 57201-3960 | 2019-05-11 |
| 1528558749 | Watertown Physician Practices LLC | Eyewear Supplier (Equipment, not the service) | 123 Hospital Dr Ste 2005, Watertown, WI 53098 | 2018-05-14 |
| 1720537277 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 216 Lewis Ave S, Watertown, MN 55388-4625 | 2016-09-26 |
| 1215292560 | Eagle Vision | Eyewear Supplier (Equipment, not the service) | 906 1/2 9th Ave Se, Watertown, SD 57201 | 2012-07-11 |
| 1063578383 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 175 Arsenal Rd, Salmon Run Mall #1300, Watertown, NY 13601-2528 | 2006-12-29 |
| 1063593614 | Stein Optical Inc | Eyewear Supplier (Equipment, not the service) | 622 S Church St, Watertown, WI 53094 | 2006-10-18 |
| 1235248121 | Precision Vision | Eyewear Supplier (Equipment, not the service) | 1300 9th Ave Se, Watertown Mall, Watertown, SD 57201-5387 | 2006-08-30 |
| 1225075138 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 1283 Arsenal St, Unit 5, Watertown, NY 13601-2252 | 2006-05-31 |
| Find all providers in WATERTOWN | ||||
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.