SHOPKO STORES OPERATING CO. LLC (NPI# 1679525109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679525109 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 084 |
| Practice Address |
1553 W 9000 S West Jordan UT 84088-9219 |
| Practice Telephone | 8015617300 |
| Mailing Telephone | 8015617300 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-07-10 |
| 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 |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| N | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| EYEMED | CP2230-54 | 01 | |
| VIP | 014084 | 01 | |
| UT | NORIDIAN SUBMITTER ID | UT04885 | 01 |
| MEDICARE | 17918 | 01 | |
| AVESIS | 35539 | 01 | |
| UT | 410985054-103 | 05 | |
| DAVIS | 42543 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 084 | 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 |
1553 W 9000 S |
| City | WEST JORDAN |
| State | UT |
| Zip Code | 84088-9219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346237393 | Ryan Paul Peterson | Family Medicine | 1553 W 9000 S, West Jordan, UT 84088-9219 | 2005-10-04 |
| 1639479678 | Ryan Dean Swensen | Pharmacist | 1553 W 9000 S, West Jordan, UT 84088-9219 | 2010-10-25 |
| 1194776005 | Jason Edward Holmes | Optometrist | 1553 W 9000 S, West Jordan, UT 84088-9219 | 2006-05-15 |
| 1669423737 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1553 W 9000 S, West Jordan, UT 84088-9219 | 2006-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881178655 | Sierra Burt | Physician Assistant | 3584 West 90000 South Suite 304, West Jordan, UT 84088 | 2018-09-18 |
| 1659861847 | Miller Anesthesia Consultants PC | Anesthesiology | Jvmc Dept. of Anesthesiology, 3580 W. 9000 S., West Jordan, UT 84088 | 2018-05-14 |
| 1821501495 | Cleo Stephanides Cheney | Dentist | 8846 South Redwood Rd., Suite N201, West Jordan, UT 84088 | 2017-11-06 |
| 1124546742 | Crystal Lynn Santos | Counselor | 4431 8200 S, West Jordan, UT 84088 | 2017-09-04 |
| 1154705960 | Heston Farnsworth | Dentist | 9217 South Redwood Road, Suite B, West Jordan, UT 84088 | 2015-07-13 |
| 1750778767 | Andrew Cantwell | Dentist | 3855 7800 South #150, West Jordan, UT 84088 | 2015-04-17 |
| 1962764282 | Steven Howard Reano | Specialist | 8789 S Redwood Road, Ste 100, West Jordan, UT 84088 | 2012-06-12 |
| 1528328846 | Orthodontic Payment Services, LLC | Dentist | 1231 W 9000 S #d, West Jordan, UT 84088 | 2012-05-21 |
| 1588932321 | Jessica Millard | Counselor | 9278 S 1700 W, West Jordan, UT 84088 | 2011-12-08 |
| 1346553062 | Barbara Rouse | Counselor | 9278 Redwood Rd, West Jordan, UT 84088 | 2010-07-22 |
| Find all providers in zip 84088 | ||||
| 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 |
|---|---|---|---|---|
| 1407412885 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1520 W 9000 S Ste E, West Jordan, UT 84088-8001 | 2019-05-11 |
| 1578987160 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 7083 S Plaza Center Dr, Suite K-2a, West Jordan, UT 84084-1762 | 2014-02-18 |
| 1073663290 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 7453 Plaza Center Dr, West Jordan, UT 84084-4323 | 2007-01-11 |
| 1639264427 | Kerry A Okelberry O D P C | Eyewear Supplier (Equipment, not the service) | 6705 Redwood Rd, West Jordan, UT 84084-2402 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053935882 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 15 S River Rd # 150, St George, UT 84790-2106 | 2020-06-08 |
| 1265088074 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 846 Expressway Ln, Spanish Fork, UT 84660-1300 | 2019-08-16 |
| 1043876428 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2843 S 5600 W Ste 170, West Valley City, UT 84120-6089 | 2019-05-11 |
| 1134785512 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2035 Harris Blvd Ste C, Layton, UT 84041-1655 | 2019-05-11 |
| 1124584529 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 1986 N Hill Field Rd Ste 5, Layton, UT 84041-2112 | 2019-02-11 |
| 1003383803 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 918 E 900 S, Salt Lake City, UT 84105-1402 | 2018-10-30 |
| 1356826010 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 4115 Riverdale Rd, Ogden, UT 84405-3509 | 2018-09-28 |
| 1003398025 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 366 E University Pkwy, Orem, UT 84058 | 2018-09-06 |
| 1790225696 | Luxottica of America Inc | Eyewear Supplier (Equipment, not the service) | 6117 S State St, Murray, UT 84107-7343 | 2017-02-27 |
| 1841681384 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 3571 W 10400 S, South Jordan, UT 84095 | 2015-02-05 |
| Find all providers with the same taxonomy | ||||
| City | WEST JORDAN |
| Zip Code | 84088 |
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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.