SHOPKO STORES OPERATING CO LLC (NPI# 1689835647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689835647 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO OPTICAL 179 |
| Practice Address |
5630 St Croix Trail North Branch MN 55056 |
| Practice Telephone | 6516749951 |
| Practice Fax Number | 6516749907 |
| Mailing Telephone | 6516749951 |
| Mailing Fax Number | 6516749907 |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2009-06-18 |
| Authorized Official Name | MR. MICHAEL 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 |
|---|---|---|---|
| MN | 1689835647 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 179 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275017907 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1166 W Sunset Drive, Suite F100, Waukesha, WI 53189 | 2018-09-19 |
| 1871076968 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1810 Jackson St, Oshkosh, WI 54901-2204 | 2018-09-13 |
| 1427547082 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 10996 N Port Washington Rd, Mequon, WI 53092 | 2018-05-08 |
| 1912454505 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 908 Nw 6th St, Tulia, TX 79088 | 2016-09-01 |
| 1821545419 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 67 Selkirk Way, Oldtown, ID 83822 | 2016-09-01 |
| 1740736586 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 94 North 400 East, Delta, UT 84624 | 2016-08-31 |
| 1639625064 | Shopko Stores Operating Co LLC | Pharmacy | 1001 N Center Ave, Hardin, MT 59034-1101 | 2016-08-26 |
| 1649726076 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1635 E Highway 40, Ballard, UT 84066-5217 | 2016-08-26 |
| 1841745155 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 301 E Us Highway 20, Gordon, NE 69343-1650 | 2016-08-17 |
| 1821441205 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 6355 Main St, Bonners Ferry, ID 83805-8519 | 2016-07-20 |
| Street Address |
5630 ST CROIX TRAIL |
| City | NORTH BRANCH |
| State | MN |
| Zip Code | 55056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811157662 | Shopko Stores Operating Co LLC | Pharmacy | 5630 St Croix Trail, North Branch, MN 55056 | 2008-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306217146 | Joy Solano | Counselor | 38873 14th Ave North, North Branch, MN 55056 | 2015-10-19 |
| 1285072637 | Teresa Ann Dewitt | Registered Nurse | 9208 St Croix Trail, North Branch, MN 55056 | 2013-06-07 |
| 1396074209 | Twin Cities Mobile Chiropractic, P.C. | Clinic/Center | 6754 380th Circle, North Branch, MN 55056 | 2009-12-24 |
| 1023171196 | Shawn Timothy Mccullough | Dentist | 6041 Main Street, Suite C, North Branch, MN 55056 | 2006-12-19 |
| 1518050103 | Paula J Rehder | Family Medicine | 6413 Oak Street, North Branch, MN 55056 | 2006-10-02 |
| 1699711614 | Julie A Perreault | Chiropractor | 6361 Main St, No Branch, MN 55056 | 2006-06-20 |
| 1760950307 | Kara H Mireles | Marriage & Family Therapist | 5842 Old Main St, Ste 2,3,4, North Branch, MN 55056 | 2018-11-12 |
| 1134614506 | Jenna Marie Leirmoe | Counselor | 38878 12th Ave, North Branch, MN 55056 | 2018-06-27 |
| 1194849687 | County Valu Pharmacy | Pharmacy | 6445 Main Street, North Branch, MN 55056 | 2007-03-19 |
| 1811081516 | Thomas A Leaf | Family Medicine | 6413 Oak Street, North Branch, MN 55056 | 2006-10-03 |
| Find all providers in zip 55056 | ||||
| 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 |
|---|---|---|---|---|
| 1972937506 | Tec LLC | Eyewear Supplier (Equipment, not the service) | 5366 386th St Ne, North Branch, MN 55056-5833 | 2013-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1891351268 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1101 E College Dr, Marshall, MN 56258-2366 | 2019-05-11 |
| 1730745100 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1459 W Service Dr, Winona, MN 55987-2512 | 2019-05-11 |
| 1649836016 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1023 E Blue Earth Ave, Fairmont, MN 56031-4076 | 2019-05-11 |
| 1124684592 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1004 18th Ave Nw Ste D, Austin, MN 55912-1993 | 2019-05-11 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1831651165 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 3366 Oakdale Ave N Ste 140, Robbinsdale, MN 55422-2961 | 2019-04-04 |
| 1538624341 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 9825 Hospital Dr # 106, Maple Grove, MN 55369-4479 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
| City | NORTH BRANCH |
| Zip Code | 55056 |
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.