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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
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 Name | Type Code |
---|---|
ShopKo Optical 111 | 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 |
1230 LANCASTER DR SE |
City | SALEM |
State | OR |
Zip Code | 97317-5800 |
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 |
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 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 |
---|---|---|---|---|
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 |
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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.