SHOPKO STORES OPERATING CO. LLC (NPI# 1477505485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477505485 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 095 |
| Practice Address |
2655 Broadway Ave Boise ID 83706-4721 |
| Practice Telephone | 2083458812 |
| Mailing Telephone | 2083458812 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-08-03 |
| 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 | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 000309600 | 05 | |
| VIP | 014095 | 01 | |
| UWG | 410985054-4095 | 01 | |
| EYEMED | 213121-3 | 01 | |
| DAVIS VISION | 42577 | 01 | |
| ID | 806430107 | 05 | |
| MEDICARE | 17839 | 01 | |
| MEDICARE | 1379405 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 095 | 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 |
2655 BROADWAY AVE |
| City | BOISE |
| State | ID |
| Zip Code | 83706-4721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326085077 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2655 Broadway Ave, Boise, ID 83706-4721 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| 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 |
|---|---|---|---|---|
| 1255757738 | Peabody Optical | Eyewear Supplier (Equipment, not the service) | 409 S 8th St Ste 101, Boise, ID 83702-7136 | 2014-03-08 |
| 1447439674 | The Frame Joint | Eyewear Supplier (Equipment, not the service) | 7905 W Ustick Rd, Suite E, Boise, ID 83704-5001 | 2007-10-24 |
| 1386799781 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 8359 W Emerald St, Boise, ID 83704 | 2007-01-24 |
| 1437207909 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 460 N Milwaukee, Boise Towne Square Mall, Boise, ID 83704-9122 | 2007-01-08 |
| 1407863145 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 300 N. Milwaukee, Boise, ID 83704 | 2006-08-02 |
| 1063803278 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 2051 S Cole Rd, Boise, ID 83709-2815 | 2015-02-10 |
| 1336547371 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 291 N Milwaukee St, Suite A-3, Boise, ID 83704-9132 | 2014-12-08 |
| 1265589048 | Eyecare Associates of Eastgate Pa | Eyewear Supplier (Equipment, not the service) | 939 W. Beacon St, Boise, ID 83706-5118 | 2007-01-04 |
| 1134295116 | Boise Vision Care, P.a. | Eyewear Supplier (Equipment, not the service) | 3293 N Milwaukee St, Boise, ID 83704-4446 | 2006-11-28 |
| 1235221268 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 350 N Milwaukee St, Suite 1188, Boise, ID 83704-9123 | 2006-09-28 |
| Find all providers in BOISE | ||||
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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.