Shopko Stores Operating Co LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

ShopKo Optical 607

Practice address

1010 South Mainline Dr
Seymour, WI 54165-1451

Phone

(920) 833-0430

NPI assigned

Jul 21, 2011

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 607 Doing business as

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318809600000",
    "number": "1477831618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 SOUTH MAINLINE DR",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "541651451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 SOUTH MAINLINE DR",
            "city": "SEYMOUR",
            "state": "WI",
            "postal_code": "541651451",
            "telephone_number": "920-833-0430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-10-17",
        "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 607",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Theresa Reed, DDS
• Lynn M Rettler, REGISTERED NURSE
• Tim Schellinger, RPH
• Seymour Chiropractic SC
• Seymour Community School District
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 607)
• Tracy Sippl, M.S., CCC-SLP
• Wade David Skogman, D.C.,C.S.C.S.,D.A.B.
• St Vincent Hospital-Hospital Sisters-Third Order of St Francis (Prevea Health-Seymour DME Supplier)
• Laura Swett, N.P.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.