Shopko Stores Operating Co LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

Shopko Optical

Practice address

3225 10TH St E
Glencoe, MN 55336-3369

Phone

(320) 864-5194

NPI assigned

Mar 29, 2013

Organization subpart

No

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

Authorized official

Name

Michael Bettiga, RPH

Title

Executive Vice President and Coo

Phone

(920) 429-4297

Specialties & licenses 1

Addresses

Other names 1

• SHOPKO OPTICAL Doing business as

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1356684245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 10TH ST E",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553363369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 10TH ST E",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553363369",
            "telephone_number": "320-864-5194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2013-03-29",
        "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_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPKO OPTICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michele Schuberg
• Rachel Marie Senske
• Linda Senst, BA
• Marty Sherman, LADC
• Shopko Stores Operating Co LLC (Shopko Pharmacy 732)
• Robin Sikkila, PHN
• Kenneth M Smith, MD
• Peter Thomas Smyth, MD
• Laurie Ann Snegosky, RN/PHN
• Kimberly Rose Sobiech, OTR/L

• Eyewear Supplier in Glencoe, MN
• Providers in Glencoe, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; 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.