Shopko Stores Operating Co. LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO. LLC

Doing business as

ShopKo Optical 029

Practice address

7401 Mineral Point Rd
Madison, WI 53717

Phone

(608) 833-5700

NPI assigned

May 16, 2006

Last updated

Jun 8, 2018By 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

Dilip Sedani

Title

E

Phone

(920) 429-7688

Specialties & licenses 1

Addresses

Other identifiers 8

Other names 1

• ShopKo Optical 029 Doing business as

Locations

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1346292745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7401 MINERAL POINT RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171703",
            "telephone_number": "608-833-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7401 MINERAL POINT RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53717",
            "telephone_number": "608-833-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "SEDANI",
        "authorized_official_first_name": "DILIP",
        "authorized_official_title_or_position": "E",
        "authorized_official_telephone_number": "920-429-7688"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIIP",
            "identifier": "014029",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NVA",
            "identifier": "410985054-4029",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS",
            "identifier": "42622",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000087848",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "17647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "CP2230-76",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "35571",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38412900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Optical 029",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ShopKo Optical 029",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Shopko Stores Operating Co. LLC (ShopKo Optical 080)
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• Shoptikal LLC (Shopko Optical 4080)
• Emma Shore, MFT-IT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.