SHOPKO STORES OPERATING CO. LLC (NPI# 1629021480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629021480 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 142 |
| Practice Address |
4810 Avenue O Fort Madison IA 52627-9677 |
| Practice Telephone | 3193728633 |
| Mailing Telephone | 3193728633 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-01-30 |
| 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 |
|---|---|---|---|
| IA | 0252080 | 05 | |
| MEDICARE | 17709 | 01 | |
| EYEMED | CP2521-2 | 01 | |
| MEDICARE | I8499 | 01 | |
| VIP | 014142 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 142 | 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 |
4810 AVENUE O |
| City | FORT MADISON |
| State | IA |
| Zip Code | 52627-9677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699726588 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 4810 Avenue O, Fort Madison, IA 52627-9677 | 2006-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538421839 | Midwest Respiratory Care Inc. | Durable Medical Equipment & Medical Supplies | 2310 Ave L, Fort Madison, IA 52627 | 2012-06-12 |
| 1013169929 | Sunnybrook of Ft. Madison | Assisted Living Facility | 5052 River Valley Road, Ft. Madison, IA 52627 | 2008-10-22 |
| 1013164532 | Navaro Noah Spartaco | Pathology | 5444 Ave O, Fort Madison, IA 52627 | 2008-08-27 |
| 1679794432 | Paul Scot Kunch | Dentist | 1605 Avenue A, Fort Madison, IA 52627 | 2007-05-01 |
| 1245364033 | David R Courtney | Dentist | 525 Avenue G, Fort Madison, IA 52627 | 2007-03-15 |
| 1578664249 | Rashid Pharmacy Plc | Durable Medical Equipment & Medical Supplies | 2404 Ave L, Fort Madison, IA 52627 | 2006-09-26 |
| 1033174628 | Leah Steffensmeier | Obstetrics & Gynecology | Fort Madison Physicians and Surgeons, 5409 Avenue O, Fort Madison, IA 52627 | 2006-04-18 |
| 1396705190 | Larry George Rounds | Chiropractor | 1605 Ave E, Fort Madison, IA 52627 | 2006-03-24 |
| 1063490407 | Air Evac Ems Inc | Ambulance | 5433 Avenue O, Fort Madison, IA 52627 | 2006-01-05 |
| 1992281984 | L.d Peck,pc | Optometrist | 716 Avenue G, Fort Madison, IA 52627 | 2018-07-13 |
| Find all providers in zip 52627 | ||||
| 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 |
|---|---|---|---|---|
| 1598188856 | International Eyecare Center, Inc | Eyewear Supplier (Equipment, not the service) | 619 10th St, Fort Madison, IA 52627-2831 | 2014-01-22 |
| 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 |
| 1588220974 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3500 Dodge St Ste 110b, Dubuque, IA 52003-5208 | 2019-05-12 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | FORT MADISON |
| Zip Code | 52627 |
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.