SHOPKO STORES OPERATING CO. LLC (NPI# 1700838729) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700838729 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO. LLC |
| Other Organization Name | SHOPKO OPTICAL 119 |
| Practice Address |
1350 N Galena Ave Dixon IL 61021-1010 |
| Practice Telephone | 8152843935 |
| Mailing Telephone | 8152843935 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2008-06-04 |
| 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 |
|---|---|---|---|
| IL | BCBS IL | 5232016 | 01 |
| MEDICARE | 17683 | 01 | |
| VIP | 014119 | 01 | |
| EYEMED | CP2230-13 | 01 | |
| DAVIS | 42531 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 119 | 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 |
1350 N GALENA AVE |
| City | DIXON |
| State | IL |
| Zip Code | 61021-1010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164539821 | Thomas Kenneth Bialecke | Optometrist | 1350 N Galena Ave, Dixon, IL 61021 | 2006-08-25 |
| 1376579334 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1350 N Galena Ave, Dixon, IL 61021-1010 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699331082 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1600 South Galena Ave, Dixon, IL 61021 | 2019-05-12 |
| 1285135590 | Richard Allen Sibert | Counselor | 325 Il Route 2,dixon Il, Dixon, IL 61021 | 2018-02-22 |
| 1518485432 | Madeline Luniewicz | Counselor | 325 Il-2, Dixon, IL 61021 | 2017-08-30 |
| 1669992566 | Nicole Marie Shaffer | Specialist/Technologist | 650 Reynoldswood Road, Dixon, IL 61021 | 2017-06-21 |
| 1346660446 | Lydia Sitter | Audiologist | 215 3. 1st Street, Suite 317, Ksb Medical Group, Dixon, IL 61021 | 2014-04-16 |
| 1053600080 | Janet I. Malmberg | Nurse Practitioner | 309 South Galena Ave, Suite 100, Dixon, IL 61021 | 2011-03-30 |
| 1376775262 | Kelly L Klein | Optometrist | 511 Palmyra Street, Ksb Eye & Vision Care, Dixon, IL 61021 | 2009-08-11 |
| 1013119106 | Michael Joseph Sarno | Physical Therapist | 401 E. First Street, Dixon, IL 61021 | 2007-06-01 |
| 1891905600 | Thomas G. Gehlbach | Internal Medicine | 215 E 1st St Ste 111, Dixon, IL 61021 | 2007-05-23 |
| 1699987230 | Sameer Jain | Family Medicine | 102 S. Hennepin Ave., Ksb Medical Group, Dixon, IL 61021 | 2007-05-04 |
| Find all providers in zip 61021 | ||||
| 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 |
|---|---|---|---|---|
| 1699331082 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1600 South Galena Ave, Dixon, IL 61021 | 2019-05-12 |
| 1780809285 | Illinois Correctional Industries | Eyewear Supplier (Equipment, not the service) | 2600 N Brinton Ave, Dixon, IL 61021-9532 | 2007-04-17 |
| 1487975603 | Ksb Medical Group, Inc. | Eyewear Supplier (Equipment, not the service) | 511 Palmyra St, Dixon, IL 61021-1953 | 2010-06-22 |
| 1306814603 | Ksb Medical Group, Inc. | Eyewear Supplier (Equipment, not the service) | 102 S Hennepin Ave, Dixon, IL 61021-3083 | 2006-03-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174138168 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1550 W Lane Rd, Machesney Park, IL 61115-1903 | 2020-09-15 |
| 1588279566 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1190 S Randall Rd Ste 104, Elgin, IL 60123-4110 | 2020-09-15 |
| 1972129294 | Luxottica Retail North America, Inc | Eyewear Supplier (Equipment, not the service) | 900 W North Ave, Chicago, IL 60642-2506 | 2020-06-23 |
| 1710512801 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 9940 Rt 47, Huntley, IL 60142 | 2020-03-09 |
| 1710512488 | Glasses On Oak St | Eyewear Supplier (Equipment, not the service) | 900 N Michigan Ave Fl 5, Chicago, IL 60611-1542 | 2020-03-03 |
| 1861026890 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 5300 Northwest Hwy, Crystal Lake, IL 60014-8072 | 2020-02-28 |
| 1952935181 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 4999 Old Orchard Ctr Ste J4, Skokie, IL 60077-1450 | 2020-02-26 |
| 1194355917 | Fr Vision 360, Inc. | Eyewear Supplier (Equipment, not the service) | 111 E Morton Ave, Jacksonville, IL 62650-3059 | 2020-01-21 |
| 1114567443 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 6215 Northwest Hwy, Crystal Lake, IL 60014-7932 | 2020-01-15 |
| 1841833399 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | Milwaukee Ave & E Towline Rd #e1600, Vernon Hills, IL 60061 | 2019-10-28 |
| Find all providers with the same taxonomy | ||||
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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.