SHOPKO STORES OPERATING CO LLC (NPI# 1942793179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942793179 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO EYECARE CENTER 4505 |
| Practice Address |
2101 E Evergreen Dr Appleton WI 54913-9001 |
| Mailing Address |
700 Pilgrim Way Green Bay WI 54304-5263 |
| Practice Telephone | 9204292211 |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-06-12 |
| Authorized Official Name | DILIP SEDANI (VP) |
| Authorized Official Telephone | 9204297688 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| Shopko Eyecare Center 4505 | 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 |
2101 E EVERGREEN DR |
| City | APPLETON |
| State | WI |
| Zip Code | 54913-9001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588846976 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2101 E Evergreen Dr, Appleton, WI 54913-9001 | 2007-11-28 |
| 1285055699 | Amy Pankow | Pharmacist | 2101 E Evergreen Dr, Appleton, WI 54913-9001 | 2014-01-02 |
| 1639509391 | Bradley Schmechel | Pharmacist | 2101 E Evergreen Dr, Appleton, WI 54913-9001 | 2013-11-17 |
| 1588004857 | Kenneth D Walker | Pharmacist | 2101 E Evergreen Dr, Appleton, WI 54913-9001 | 2013-07-01 |
| 1932545852 | Suzanne Mary Luniak | Pharmacist | 2101 E Evergreen Dr, Appleton, WI 54913-9001 | 2013-05-18 |
| 1114269388 | Jesica R Schoen | Pharmacist | 2101 E Evergreen Dr, Appleton, WI 54913-9001 | 2013-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| Find all providers in zip 54913 | ||||
| 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 |
|---|---|---|---|---|
| 1871159244 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1490 Oneida St, Appleton, WI 54915-7100 | 2019-05-11 |
| 1982260352 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3525 E Calumet St Ste 1400, Appleton, WI 54915-4181 | 2019-05-11 |
| 1174622583 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 4301 W Wisconsin Ave, Fox River Mall #144, Appleton, WI 54913-8605 | 2006-09-22 |
| 1508422924 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1033 W Northland Ave Ste B, Appleton, WI 54914-1499 | 2019-05-10 |
| 1265830301 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 2600 W College Ave, Suite 1a, Appleton, WI 54914-4200 | 2014-12-05 |
| 1588993711 | Pearle Vision Inc | Eyewear Supplier (Equipment, not the service) | 4301 W Wisconsin Ave, Fox River Mall, Appleton, WI 54913-8605 | 2009-12-17 |
| 1114100518 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | W3208 Van Roy Rd, Appleton, WI 54915 | 2007-12-10 |
| 1114075975 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 4301 W Wisconsin Ave, Fox River Mall, Appleton, WI 54913-8605 | 2007-01-08 |
| 1043386600 | Optivision Eye Care LLP | Eyewear Supplier (Equipment, not the service) | 223 S Nicolet Rd, Appleton, WI 54914-3938 | 2006-11-27 |
| 1245328616 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 4301 W Wisconsin Ave, Fox River Mall #812, Appleton, WI 54913-8605 | 2006-10-11 |
| Find all providers in APPLETON | ||||
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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.