Shopko Stores Operating Co LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

1166 W Sunset Drive
Suite F100
Waukesha, WI 53189

Phone

(920) 429-2211

NPI assigned

Sep 19, 2018

Organization subpart

No

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

Authorized official

Name

Dilip Sedani

Title

VP

Phone

(920) 429-7688

Specialties & licenses 1

Addresses

Other names 1

• Shopko Eyecare Center 4217 Doing business as

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

{
    "created_epoch": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537315200000",
    "number": "1275017907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 PILGRIM WAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1166 W SUNSET DRIVE",
            "address_2": "SUITE F100",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53189",
            "telephone_number": "920-429-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A",
        "authorized_official_last_name": "SEDANI",
        "authorized_official_first_name": "DILIP",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "920-429-7688"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Eyecare Center 4217",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Eyewear Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; 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.