SHOPKO STORES OPERATING CO LLC (NPI# 1942483342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942483342 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO OPTICAL 177 |
| Practice Address |
2320 Lineville Rd Green Bay WI 54313-8836 |
| Practice Telephone | 9204345845 |
| Mailing Telephone | 9204345845 |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | 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 |
|---|---|---|---|
| VIP | 125950 | 01 | |
| AVESIS | 47608 | 01 | |
| UNTIED HEALTHCARE | 1952356644 | 01 | |
| RR MC | DF0804 | 01 | |
| DAVIS | 58936 | 01 | |
| NETWORK HEALTH | 1952356644 | 01 | |
| EYEMED | 146151 | 01 | |
| WI | 38461000 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Optical 177 | 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 |
2320 LINEVILLE RD |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54313-8836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033392436 | Shopko Stores Operating Co LLC | Pharmacy | 2320 Lineville Rd, Green Bay, WI 54313-8836 | 2007-12-10 |
| 1669818696 | Cheryl Ann Zambrowicz | Pharmacist | 2320 Lineville Rd, Green Bay, WI 54313-8836 | 2013-05-16 |
| 1770729485 | Cindy Aiken | Nurse Practitioner | 2320 Lineville Rd, Green Bay, WI 54313-8836 | 2008-12-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548823420 | Martha Lynn Drew | Licensed Practical Nurse | 3101 Molly Brown Lane, Green Day, WI 54313 | 2019-04-17 |
| 1831691872 | Melanie Hammerbeck | Dentist | 1756 Cardinal Ln, Green Bay, WI 54313 | 2018-03-06 |
| 1649727108 | Amanda Marie Mckeefry | Dental Hygienist | 2304 Lineville Rd, Suite 101, Green Bay, WI 54313 | 2016-09-01 |
| 1326594813 | Kaylee Schartner | Dental Hygienist | 2304 Lineville Road, Suite 100, Suamico, WI 54313 | 2016-08-25 |
| 1134500226 | Salvanz Enterprises Inc | Pharmacy | 2673 Lineville Road, Green Bay, WI 54313 | 2015-06-15 |
| 1467849307 | Maureen Riordan | Specialist/Technologist | 2957 S Telemark Cir., Green Bay, WI 54313 | 2015-04-17 |
| 1043556780 | Kellen James Binder | Chiropractor | 2638 Tulip Lane, Suite B, Green Bay, WI 54313 | 2012-12-28 |
| 1407092737 | Sara Ann Anderson | Registered Nurse | 2691 Shade Tree Ln, Green Bay, WI 54313 | 2008-12-16 |
| 1467601344 | Melissa Lea Socha | Speech-Language Pathologist | 2153 School Lane, Suamiro Elementary, Green Bay, WI 54313 | 2008-09-16 |
| 1003070707 | Anne Marie Hein | Physical Therapist | 3101 S Packerland Dr, Green Bay, WI 54313 | 2008-07-11 |
| Find all providers in zip 54313 | ||||
| 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 |
|---|---|---|---|---|
| 1639784622 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2268 W Mason St, Green Bay, WI 54303-4707 | 2020-09-15 |
| 1194381509 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2300 Lineville Rd Ste 109, Green Bay, WI 54313-8859 | 2019-05-13 |
| 1710543228 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2360 Costco Way Ste 120, Green Bay, WI 54311-9210 | 2019-05-10 |
| 1659937159 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 2621 S Oneida St Ste 104, Green Bay, WI 54304-5793 | 2019-05-10 |
| 1376743351 | Essilor Laboratories of America, Inc. | Eyewear Supplier (Equipment, not the service) | 2985 S Ridge Rd, Green Bay, WI 54304-5565 | 2007-07-19 |
| 1194870907 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 303 Bay Park Sq Ste 976, Green Bay, WI 54304-5104 | 2007-01-24 |
| 1487753927 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 191 Bay Parks Square Mall, Green Bay, WI 54304-5102 | 2006-09-21 |
| 1144327149 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 1555 Green Bay Plaza, Green Bay, WI 54304-2143 | 2006-09-20 |
| 1952356644 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-05-23 |
| 1316504970 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2019-05-20 |
| Find all providers in GREEN BAY | ||||
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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.