SHOPKO STORES OPERATING CO LLC


Address: 1230 Lancaster Dr Se, Salem, OR 97317-5800
Phone: 5033716575

SHOPKO STORES OPERATING CO LLC (NPI# 1790736023) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790736023
Entity Type Organization
Organization Name SHOPKO STORES OPERATING CO LLC
Other Organization Name SHOPKO OPTICAL 111
Practice Address 1230 Lancaster Dr Se
Salem
OR 97317-5800
Practice Telephone 5033716575
Mailing Telephone 5033716575
Enumeration Date 2006-05-12
Last Update Date 2008-11-20
Authorized Official Name MR. MICHAEL J BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES)
Authorized Official Telephone 9204294297
Authorized Official Credential RPH
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 332H00000X Eyewear Supplier (Equipment, not the service) Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
OR 039912 05
AVESIS 35512 01
OR 039904 05
NVA 410985054-4111 01
EYEMED CP2230-36 01
VIP 014111 01
DAVIS VISION 42514 01

Other Provider/Organization Names

Other Name Type Code
ShopKo Optical 111 Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 1230 LANCASTER DR SE
City SALEM
State OR
Zip Code 97317-5800

Providers in the same location

NPI Name Taxonomy Address Enumeration
1669950325 Julie Trinh Le Pharmacist 1230 Lancaster Dr Se, Salem, OR 97317-5800 2018-08-03
1679029326 Adam Nguyen Pharmacist 1230 Lancaster Dr Se, Salem, OR 97317-5800 2016-08-31
1306110143 Leslie Aaron Eddleman Pharmacist 1230 Lancaster Dr Se, Salem, OR 97317-5800 2012-02-24
1689947046 Sylvia Kay Fisher Pharmacist 1230 Lancaster Dr Se, Salem, OR 97317-5800 2012-02-15
1629341037 Jerry Gary Sachtjen Pharmacist 1230 Lancaster Dr Se, Salem, OR 97317-5800 2012-02-15
1639121155 Shopko Stores Operating Co LLC Durable Medical Equipment & Medical Supplies 1230 Lancaster Dr Se, Salem, OR 97317-5800 2006-05-16

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1962932996 Corinna Leona Zib Counselor 4726 Appaloosa Ct Se, Salem, OR 97317 2017-06-13
1639537889 Nikole Stormo Massage Therapist 4675 Campbell Dr Se Apt267, Salem, OR 97317 2016-02-03
1174698971 Christian Community Placement Center Foster Care Agency 4890 32nd Ave Se, Salem, OR 97317 2006-11-21
1235653569 Alexis Panther Community Health Worker 4890 32nd Ave Se, Salem, OR 97317 2017-07-28
1114479128 Jocelyn Gran Pharmacist 2400 Lancaster Dr Ne, Salem, OR 97317 2016-10-26
1841410057 Jennifer Krug Specialist/Technologist 5000 Deer Park Dr Se, Salem, OR 97317 2007-04-27
1649498262 Carol Adams Social Worker 1164 63rd Ave Ne, Salem, OR 97317-2313 2007-04-20
1992114490 Pathways - Child and Family Services - LLC Community/Behavioral Health 1164 63rd Ave Ne, Salem, OR 97317-2313 2014-08-08
1417513235 James Matthew Conway Social Worker 5100 Center St Ne, Salem, OR 97317-3217 2019-05-16
1043876865 Home Inc. Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 5100 Center St Ne, Salem, OR 97317-3217 2019-05-16
Find all providers in zip 97317

Taxonomy Information

Taxonomy Code 332H00000X
Grouping Suppliers
Classification Eyewear Supplier (Equipment, not the service)

Taxonomy Definition

An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1457967135 Bj's Wholesale Club Inc. Eyewear Supplier (Equipment, not the service) 70 Cluff Rd, Salem, NH 03079-3324 2020-09-18
1457578627 Willamette Valley Eyewear Eyewear Supplier (Equipment, not the service) 2001 Commercial St Se, Salem, OR 97302-5207 2007-04-19
1437203627 Usv Optical Inc. Eyewear Supplier (Equipment, not the service) 70 Cluff Road, Salem, NH 03079 2007-01-23
1871640318 Luxottica Retail North America Inc Eyewear Supplier (Equipment, not the service) 823 Lancaster Dr Ne, Lancaster Mall, Salem, OR 97301-2929 2007-01-05
1306993480 Luxottica Retail North America Inc Eyewear Supplier (Equipment, not the service) 77 Rockingham Park Blvd, The Mall At Rockingham Park, Salem, NH 03079-2964 2007-01-04
1467513457 Luxottica of America Inc. Eyewear Supplier (Equipment, not the service) 99 Rockingham Park Blvd, Salem, NH 03079-2900 2006-12-13
1497844435 Visionworks, Inc. Eyewear Supplier (Equipment, not the service) 831 Lancaster Drive Ne, Salem, OR 97301 2006-10-11
1922019843 Usv Optical Inc. Eyewear Supplier (Equipment, not the service) 81 Rockingham Park Blvd, Salem, NH 03079 2006-08-10
1285677815 National Vision, Inc. Eyewear Supplier (Equipment, not the service) 300-344 N. Broadway, Salem, NH 03079 2006-06-13
1760449474 Empire Vision Center Inc Eyewear Supplier (Equipment, not the service) 346 South Broadway, Cambridge Eye Doctors, Salem, NH 03079-4304 2006-04-27
Find all providers in SALEM

Competitor

Search similar providers

City SALEM
Zip Code 97317

Improve Information

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Dataset Information

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.

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