SHOPKO STORES OPERATING CO. LLC (NPI# 1518910140) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518910140 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 164 |
| Practice Address |
255 John F Kennedy Rd Dubuque IA 52002-5313 |
| Practice Telephone | 5635835895 |
| Mailing Telephone | 5635835895 |
| 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 |
|---|---|---|---|
| AVESIS | 35437 | 01 | |
| EYEMED | OP1541 | 01 | |
| IA | 025-6347 | 05 | |
| MEDICARE | 17711 | 01 | |
| VIP | 014164 | 01 | |
| MEDICARE | 70091 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 164 | 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 |
255 JOHN F KENNEDY RD |
| City | DUBUQUE |
| State | IA |
| Zip Code | 52002-5313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407807308 | Shopko Stores Operating Co LLC | Pharmacy | 255 John F Kennedy Rd, Dubuque, IA 52002-5313 | 2006-05-15 |
| 1609256627 | Theresa Mccartney | Optometrist | 255 John F Kennedy Rd, Dubuque, IA 52002-5313 | 2015-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144725193 | Rebecca Marie Fitzpatrick | Pharmacist | 7425 Chavenelle Rd Ste 300, Dubuque, IA 52002 | 2018-03-29 |
| 1598020943 | Steven Matthew Leifker | Dentist | 1645 John F. Kennedy Rd, Dubuque, IA 52002 | 2012-07-11 |
| 1922364280 | Susan A Neuser | Pharmacist | 74 25 Chavenelle Rd, Dubuque, IA 52002 | 2012-04-11 |
| 1720308240 | Yakov S Zagalskiy | Family Medicine | 1500 Associates Drive, Dubuque, IA 52002 | 2010-06-07 |
| 1689904690 | Meryl Rae Welsh | Counselor | 2255 Jkf Road, Dubuque, IA 52002 | 2010-01-14 |
| 1982864047 | Joel Gregory Thielen | Acupuncturist | 1880 Radford Road, Dubuque, IA 52002 | 2008-06-12 |
| 1609052323 | Jason E Meyer Physical Therapy PC | Clinic/Center | 2300 John F Kennedy Rd, Dubuque, IA 52002 | 2008-01-11 |
| 1508053828 | Assisted Living Concepts Inc | Assisted Living Facility | 2700 Matthew John Drive, Dubuque, IA 52002 | 2007-10-01 |
| 1588863252 | Miracle Ear | Audiologist-Hearing Aid Fitter | 555 Jf Kennedy Road, Dubuque, IA 52002 | 2007-07-13 |
| 1639383599 | Michelle Ann Gardner | Optometrist | 808 Wacker Dr, Dubuque, IA 52002 | 2007-05-10 |
| Find all providers in zip 52002 | ||||
| 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 |
|---|---|---|---|---|
| 1588220974 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3500 Dodge St Ste 110b, Dubuque, IA 52003-5208 | 2019-05-12 |
| 1700188034 | Eye-deal Optical Inc. | Eyewear Supplier (Equipment, not the service) | 1950 John F Kennedy Rd, Dubuque, IA 52002-3897 | 2010-11-18 |
| 1740334473 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 555 Jfk Rd Ste 604, Dubuque, IA 52002-5207 | 2007-01-22 |
| 1699173658 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 3432 Dodge St, Suite 108, Dubuque, IA 52003-5277 | 2014-12-08 |
| 1902940166 | Klauer Optical Co | Eyewear Supplier (Equipment, not the service) | 1705 Delhi St, Dubuque, IA 52001-5934 | 2007-02-19 |
| 1487710620 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 555 John F Kennedy Rd, Kennedy Mall Ste #400, Dubuque, IA 52002-5202 | 2006-12-30 |
| 1508963778 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 808 Wacker Dr, Dubuque, IA 52002-5224 | 2006-09-20 |
| 1043282148 | Fuerste Eye Clinic | Eyewear Supplier (Equipment, not the service) | 2140 Jfk Rd, Ste F, Dubuque, IA 52002-3883 | 2006-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538711775 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 440 S 68th St Ste 107-108, West Des Moines, IA 50266-8431 | 2019-07-09 |
| 1215593686 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2927 Hamilton Blvd, Sioux City, IA 51104-2405 | 2019-05-11 |
| 1104482579 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3570 4th St Sw Ste 400, Mason City, IA 50401-1550 | 2019-05-11 |
| 1902382773 | Vision4less | Eyewear Supplier (Equipment, not the service) | 1810 N Coral St, Coralville, IA 52241-7606 | 2018-07-16 |
| 1487147963 | Mcfarland Clinic, PC | Eyewear Supplier (Equipment, not the service) | 3500 University Blvd., Suite 1001, Ames, IA 50010 | 2018-06-11 |
| 1043760093 | Hw Holdings | Eyewear Supplier (Equipment, not the service) | 2027 Crossroads Blvd, Waterloo, IA 50702-4405 | 2016-10-13 |
| 1053861005 | Hw Holdings | Eyewear Supplier (Equipment, not the service) | 1035 Lawrence St Ste 106, Burlington, IA 52601-1549 | 2016-10-13 |
| 1659705051 | Glasses Connect Inc. | Eyewear Supplier (Equipment, not the service) | 5801 Se 24th St Unit 75, Des Moines, IA 50320-4704 | 2013-08-21 |
| 1639475197 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 4444 1st Ave Ne Ste 575, Cedar Rapids, IA 52402 | 2011-02-01 |
| 1033423751 | Value Vision Express | Eyewear Supplier (Equipment, not the service) | 8421 University Blvd Ste H2, Clive, IA 50325-1036 | 2010-08-05 |
| 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.