Shopko Stores Operating Co. LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO. LLC

Doing business as

ShopKo Optical 123

Practice address

900 Memorial Rd
Houghton, MI 49931-2481

Phone

(906) 487-9767

NPI assigned

May 16, 2006

Last updated

Nov 3, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Russell Steinhorst

Title

SVP Chief Financial Officer

Phone

(920) 429-7489

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• ShopKo Optical 123 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1073565594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MEMORIAL RD",
            "city": "HOUGHTON",
            "state": "MI",
            "postal_code": "499312481",
            "telephone_number": "906-487-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MEMORIAL RD",
            "city": "HOUGHTON",
            "state": "MI",
            "postal_code": "499312481",
            "telephone_number": "906-487-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "SVP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "920-429-7489",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "410985054-4123",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0P06340",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "213121-10",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "35463",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "42538",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIP",
            "identifier": "014123",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "17876",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Optical 123",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Diane Schwass
• Mary Angela Sergeyeva
• Mark Richard Shebuski, M.D.
• Michael Sheridan
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 2123)
• Shoptikal LLC (Shopko Optical 4314)
• Scott Alan Shoup, M.D.
• Candace Silvola, RPH
• Smith Holistic Care, LLC
• Heather Smith, FNP

• Eyewear Supplier in Houghton, MI
• Providers in Houghton, MI by specialty
• Eyewear Supplier in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.