SHOPKO STORES OPERATING CO. LLC (NPI# 1588616692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588616692 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 008 |
| Practice Address |
1039 E Grand Ave Rothschild WI 54474-1022 |
| Practice Telephone | 7153590649 |
| Mailing Telephone | 7153590649 |
| 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 |
|---|---|---|---|
| VIP | 014008 | 01 | |
| AVESIS | 35589 | 01 | |
| WI | 38413100 | 05 | |
| MEDICARE | 87830 | 01 | |
| MEDICARE | 17639 | 01 | |
| NVA | 410985054-4008 | 01 | |
| DAVIS | 42530 | 01 | |
| EYEMED | CP2230-89 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 008 | 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 |
1039 E GRAND AVE |
| City | ROTHSCHILD |
| State | WI |
| Zip Code | 54474-1022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144271362 | Courtney Lee O'keefe | Optometrist | 1039 E Grand Ave, Rothschild, WI 54474-1022 | 2006-05-12 |
| 1518523034 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1039 E Grand Ave, Rothschild, WI 54474-1022 | 2019-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023063294 | Shopko Stores Operating Co LLC | Pharmacy | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2006-05-24 |
| 1114319795 | Jacie Cihlar | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2015-02-19 |
| 1487084232 | Rodney Lee Rogalla | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2013-11-14 |
| 1093153868 | Scott John Vanermen | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2013-06-13 |
| 1619221371 | Stephanie Michelle Masterson | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2012-11-02 |
| 1649497033 | Jody A Osowski | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2007-04-19 |
| 1346463114 | Timothy Allen Condon | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2007-04-10 |
| 1609168772 | Nicole M Klatt | Audiologist | 903 Grand Ave Ste C-2, Rothschild, WI 54474-1065 | 2011-05-09 |
| 1326670811 | Winding Creek Audiology & Hearing Aid Care LLC | Audiologist | 903 Grand Ave Ste C-2, Rothschild, WI 54474-1065 | 2020-02-12 |
| 1154577898 | Szmanda Dental Center | Dentist | 24 Brown Blvd, Rothschild, WI 54474-1111 | 2008-08-13 |
| Find all providers in zip 54474 | ||||
| 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 |
|---|---|---|---|---|
| 1518523034 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1039 E Grand Ave, Rothschild, WI 54474-1022 | 2019-05-10 |
| 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 |
| 1427669746 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1607 Losey Blvd S, La Crosse, WI 54601-6151 | 2020-08-11 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | ROTHSCHILD |
| Zip Code | 54474 |
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.