SHOPKO STORES OPERATING CO. LLC (NPI# 1548213184) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548213184 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 007 |
| Practice Address |
4344 Mormon Coulee Rd La Crosse WI 54601-7908 |
| Practice Telephone | 6087888800 |
| Mailing Telephone | 6087888800 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-02-08 |
| 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 |
|---|---|---|---|
| MEDICARE | 17638 | 01 | |
| VIP | 014007 | 01 | |
| AVESIS | 35570 | 01 | |
| MEDICARE | 000087829 | 01 | |
| DAVIS | 42527 | 01 | |
| WI | 38423700 | 05 | |
| EYEMED | CP2230-75 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 007 | 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 |
4344 MORMON COULEE RD |
| City | LA CROSSE |
| State | WI |
| Zip Code | 54601-7908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528018975 | Colleen Nicole Konkel | Optometrist | 4344 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2006-05-10 |
| 1063851020 | Matthew John Fernholz | Pharmacist | 4344 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2013-06-22 |
| 1346686300 | Marc Christopher Ertz | Pharmacist | 4344 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2013-05-17 |
| 1386997294 | Ryan Barfknecht | Pharmacist | 4344 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2012-10-17 |
| 1457647125 | Amanda Renee Cheek | Optometrist | 4344 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2011-06-21 |
| 1093761447 | Shopko Stores Operating Co LLC | Pharmacy | 4344 Mormon Coulee Rd, La Crosse, WI 54601-7908 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891324265 | Meagan Mcrae | Student in an Organized Health Care Education/Training Program | 1725 State St., 4051 Health Science Center, La Crosse, WI 54601 | 2020-04-07 |
| 1255969671 | Erin Dingman | Student in an Organized Health Care Education/Training Program | 1751 State Street, 4051 Health Science Center, La Crosse, WI 54601 | 2020-03-31 |
| 1619505047 | Nicole Kay Lynch | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State St, La Crosse, WI 54601 | 2020-03-31 |
| 1174151757 | Jenna Sells | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1740818301 | Katie Irene Tahtinen | Student in an Organized Health Care Education/Training Program | Uwl- 4051 Health Science Center, 1725 State St., La Crosse, WI 54601 | 2020-03-30 |
| 1932737517 | Margaret May Grimm | Student in an Organized Health Care Education/Training Program | Univesity of Wisconsin-la Crosse, 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1831727312 | Matthew Timothy Axler | Student in an Organized Health Care Education/Training Program | 4051 Health Science Center, 1725 State Street, La Crosse, WI 54601 | 2020-03-30 |
| 1093340473 | Denise Stinson | Technician | 1311 Badger St, Apt 505, La Crosse, WI 54601 | 2020-03-06 |
| 1922632397 | Ibrahim Ahsan | Pharmacist | 1105 Wi-16, La Crosse, WI 54601 | 2020-02-25 |
| 1750913356 | Liza R Collins | Massage Therapist | 1415 State Wi 16, La Crosse, WI 54601 | 2020-02-11 |
| Find all providers in zip 54601 | ||||
| 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 |
|---|---|---|---|---|
| 1427669746 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1607 Losey Blvd S, La Crosse, WI 54601-6151 | 2020-08-11 |
| 1982769626 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 3800 State Rd, Valley View Mall #16, La Crosse, WI 54601 | 2006-12-22 |
| 1932284494 | Vision World Inc | Eyewear Supplier (Equipment, not the service) | 3800 State Road 16, La Crosse, WI 54603 | 2006-10-25 |
| 1285733667 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 4200 Us Hwy #16, Valley View Mall, La Crosse, WI 54601-4601 | 2006-09-21 |
| 1467850529 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 3800 State Road 16, Suite 146, La Crosse, WI 54601-1826 | 2014-12-05 |
| 1801173356 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 3800 State Road 16, La Crosse, WI 54601-1826 | 2011-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658772 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1073 E Johnson St, Fond Du Lac, WI 54935-8919 | 2020-10-27 |
| 1578170247 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 120 N Grand Ave Ste 102, Sun Prairie, WI 53590-9007 | 2020-09-28 |
| 1639784622 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2268 W Mason St, Green Bay, WI 54303-4707 | 2020-09-15 |
| 1710598032 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 631 Hometown Cir Ste 106, Verona, WI 53593-1561 | 2020-08-11 |
| 1871138073 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 723 Main Ave, Depere, WI 54115 | 2019-11-12 |
| 1558903815 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 422 Gammon Pl, Madison, WI 53719-1026 | 2019-10-08 |
| 1669013256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 123 N Mall Dr, Grand Chute, WI 54913-8531 | 2019-10-04 |
| 1952962763 | Martell Eyecare, LLC | Eyewear Supplier (Equipment, not the service) | 703 Third Street, Marathon, WI 54448 | 2019-06-23 |
| 1932767316 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1440 Capital Drive, Suite B, Pewaukee, WI 53072 | 2019-05-31 |
| 1942866066 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 9417 State Road 16 Ste 300, Onalaska, WI 54650-8539 | 2019-05-14 |
| 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.