SHOPKO STORES OPERATING CO. LLC (NPI# 1558313783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558313783 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 045 |
| Practice Address |
601 Galvin Rd S Bellevue NE 68005-2249 |
| Practice Telephone | 4022931840 |
| Mailing Telephone | 4022931840 |
| Enumeration Date | 2006-05-16 |
| 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 |
|---|---|---|---|
| DAVIS | 35861 | 01 | |
| BLOCK | 003340 | 01 | |
| VIP | 014045 | 01 | |
| NE | 10025073800 | 05 | |
| EYEMED | 213121-22 | 01 | |
| MEDICARE | 17885 | 01 | |
| AVESIS | 35495 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 045 | 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 |
601 GALVIN RD S |
| City | BELLEVUE |
| State | NE |
| Zip Code | 68005-2249 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740231109 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 601 Galvin Rd S, Bellevue, NE 68005-2249 | 2006-05-12 |
| 1285687442 | Russell Smith | Optometrist | 601 Galvin Rd S, Bellevue, NE 68005-2249 | 2006-05-18 |
| 1821049131 | Mark Dennis Greenwell | Optometrist | 601 Galvin Rd S, Bellevue, NE 68005-2249 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750988325 | Melissa Ann Jansen | Social Worker | Mission Middle School, Bellevue, NE 68005 | 2020-10-06 |
| 1295352144 | Angel Lowery | Counselor | 112 E Mission Ave, Bellevue, NE 68005 | 2020-06-26 |
| 1760915656 | Maria Clark | Counselor | 1620 Wilshire Dr Ste 222, Bellevue, NE 68005 | 2017-04-06 |
| 1427420512 | Daryan Whaler | Specialist/Technologist | 1000 Galvin Rd S, Bellevue, NE 68005 | 2015-10-28 |
| 1750704623 | Joseph Gavis Councill IIi | Nurse Practitioner | 919 Galvin Rd. S., Suite A, Bellevue, NE 68005 | 2014-01-29 |
| 1205265501 | Rebecca Parsons | Speech-Language Pathologist | 510 W 22nd Avenue, Bellevue, NE 68005 | 2013-11-06 |
| 1649524174 | Tammy Lee Winkler-bitzes | Physical Therapist | 1820 Hillcrest Dr Suite A, Belleuve, NE 68005 | 2012-11-06 |
| 1811268311 | Charice M Butler | Counselor | 919 Galvin Rd S. Ste A, Bellevue, NE 68005 | 2012-01-16 |
| 1184991945 | Angela M Matney | Pharmacist | Hwy 370 & Galvin Road, Bellevue, NE 68005 | 2011-11-22 |
| 1770878852 | Sarah Cathryn Sedlak | Physical Therapist | 2206 Longo Drive, Ste 211, Excel Physical Therapy, Bellevue, NE 68005 | 2011-06-16 |
| Find all providers in zip 68005 | ||||
| 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 |
|---|---|---|---|---|
| 1619514825 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 11111 Ne 8th St Ste 147, Bellevue, WA 98004-4489 | 2019-12-06 |
| 1760048136 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 848 Cornhusker Rd Ste 105, Bellevue, NE 68123-4433 | 2019-05-11 |
| 1295935575 | Bellevue Vision Co | Eyewear Supplier (Equipment, not the service) | 568 Lincoln Ave, Bellevue, PA 15202-3530 | 2007-07-24 |
| 1811051428 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 3923 Factoria Square Mall Se, Bellevue, WA 98006-1264 | 2006-12-20 |
| 1699712935 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 2041 148th Ave Ne, Bellevue, WA 98007-3725 | 2006-06-02 |
| 1295386027 | Eye Society Bellevue Pllc | Eyewear Supplier (Equipment, not the service) | 700 110th Ave Ne Ste 255, Bellevue, WA 98004-5151 | 2019-09-23 |
| 1366961534 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 400 Bellevue Sq, Bellevue, WA 98004-5002 | 2017-09-19 |
| 1831580976 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 2355 Costco Way, Bellevue, WI 54311-9206 | 2015-02-11 |
| 1629367826 | Eye Society | Eyewear Supplier (Equipment, not the service) | 700 110th Ave Ne, Suite 255, Bellevue, WA 98004-5119 | 2011-03-29 |
| 1093830648 | Eye Clinic of Bellevue Ltd Ps | Eyewear Supplier (Equipment, not the service) | 1300 116th Ave Ne, Bellevue, WA 98004-3808 | 2007-03-20 |
| Find all providers in BELLEVUE | ||||
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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.