SHOPKO STORES OPERATING CO. LLC (NPI# 1528010642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528010642 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 060 |
| Practice Address |
2610 Bridge Ave Albert Lea MN 56007-2075 |
| Practice Telephone | 5073732269 |
| Mailing Telephone | 5073732269 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-04-15 |
| 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 |
|---|---|---|---|
| MN MA FIRST PLAN OF MN | 30328SH | 01 | |
| MN HEALTH PARTNERS | 36059 | 01 | |
| DAVIS | 42496 | 01 | |
| MEDICARE | 17831 | 01 | |
| MN MA MEDICA CHOICE CARE | 21000715 | 01 | |
| AVESIS | 35466 | 01 | |
| NATIONAL VISION ADMIN. | 410985054-4060 | 01 | |
| EYEMED | CP2230-17 | 01 | |
| MN BLUE PLUS CARE | 30329SH | 01 | |
| VIP | 014060 | 01 | |
| MN MA PRIMEWEST HEALTH | 03092036206 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 060 | 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 |
2610 BRIDGE AVE |
| City | ALBERT LEA |
| State | MN |
| Zip Code | 56007-2075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144271750 | Daniel Maurice Cottrell | Optometrist | 2610 Bridge Ave, Albert Lea, MN 56007-2075 | 2006-05-16 |
| 1700370749 | Jacob Erickson | Optometrist | 2610 Bridge Ave, Albert Lea, MN 56007-2075 | 2018-06-21 |
| 1265850085 | Andrew Rozinka | Pharmacist | 2610 Bridge Ave, Albert Lea, MN 56007-2075 | 2014-03-29 |
| 1184041543 | John Denow | Pharmacist | 2610 Bridge Ave, Albert Lea, MN 56007-2075 | 2014-03-24 |
| 1629398516 | Toni Lynn Watt | Optometrist | 2610 Bridge Ave, Albert Lea, MN 56007-2075 | 2010-06-02 |
| 1205880010 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2610 Bridge Ave, Albert Lea, MN 56007-2075 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700395860 | Kelsey Paulson | Massage Therapist | 1629 West Main Street, Touchworks Massage Skyline Plaza, Albert Lea, MN 56007 | 2017-09-21 |
| 1366984536 | Allied Health Care Professional Service Corporation | Health Maintenance Organization | 140 W Clark St, Albert Lea, MN 56007 | 2016-11-05 |
| 1174875165 | Michael Gene White | Pharmacist | 1615 West Main St, Albert Lea, MN 56007 | 2012-10-15 |
| 1841596384 | Elizabeth Jordan Berg | Chiropractor | 72599 220th St, Albert Lea, MN 56007 | 2011-02-01 |
| 1235453606 | Michael Aaron Starner | Physician Assistant | 404 W Fountain St Unit 516, Albert Lea, MN 56007 | 2010-03-15 |
| 1215149364 | John M Enger, Professional Association | Podiatrist | 904 E Plaza Street, Albert Lea, MN 56007 | 2007-05-03 |
| 1760532485 | Lowell Wherry Barr | Pediatrics | 203 W Clark, Albert Lea, MN 56007 | 2007-01-12 |
| 1073688917 | Wendy Elizabeth Walker | Psychologist | 117 South Newton Avenue, Albert Lea, MN 56007 | 2006-11-22 |
| 1487739090 | Rem Woodvale Inc | Intermediate Care Facility, Mentally Retarded | 1204 Plainview Lane, Albert Lea, MN 56007 | 2006-10-25 |
| 1275621294 | Eleanor Wanden | Technician | 1815 Minnesota Ave, Albert Lea, MN 56007 | 2006-10-11 |
| Find all providers in zip 56007 | ||||
| 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 |
|---|---|---|---|---|
| 1396832606 | Mayo Clinic Health System-southeast Minnesota Region | Eyewear Supplier (Equipment, not the service) | 404 W Fountain St Ste 3, Albert Lea, MN 56007-2437 | 2006-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1891351268 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1101 E College Dr, Marshall, MN 56258-2366 | 2019-05-11 |
| 1730745100 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1459 W Service Dr, Winona, MN 55987-2512 | 2019-05-11 |
| 1649836016 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1023 E Blue Earth Ave, Fairmont, MN 56031-4076 | 2019-05-11 |
| 1124684592 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1004 18th Ave Nw Ste D, Austin, MN 55912-1993 | 2019-05-11 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1831651165 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 3366 Oakdale Ave N Ste 140, Robbinsdale, MN 55422-2961 | 2019-04-04 |
| 1538624341 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 9825 Hospital Dr # 106, Maple Grove, MN 55369-4479 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
| City | ALBERT LEA |
| Zip Code | 56007 |
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.