Shopko Stores Operating Co LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

126 Charles St
Oconto, WI 54153-9446

Phone

(920) 834-1111

Fax

(920) 834-9801

NPI assigned

May 19, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Michael Bettiga, RPH

Title

Executive Vice President and Coo

Phone

(920) 429-4297

Specialties & licenses 1

Addresses

Other names 1

• ShopKo Optical 602 Doing business as

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311638400000",
    "number": "1346569183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 CHARLES ST",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541539446",
            "telephone_number": "920-834-1111",
            "fax_number": "920-834-9801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 CHARLES ST",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541539446",
            "telephone_number": "920-834-1111",
            "fax_number": "920-834-9801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2011-07-26",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Optical 602",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bruce W Retzlaff, MSW
• Megan Ann Robers, PT, DPT
• Elizabeth Joyce Russell, M.D.
• David Schreiter, CSAC
• Shopko #602
• Shopko Stores Operating Co LLC
• Joshua M Simpson, DMD
• Marissa Spatz
• St Clare Memorial Hospital, Inc
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2011; 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.