Shopko Stores Operating Co. LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO. LLC

Doing business as

ShopKo Optical 060

Practice address

2610 Bridge Ave
Albert Lea, MN 56007-2075

Phone

(507) 373-2269

NPI assigned

May 17, 2006

Last updated

Apr 15, 2008By 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

Michael J Bettiga, RPH

Title

Sr. Vice President Health Services

Phone

(920) 429-4297

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• ShopKo Optical 060 Doing business as

Locations (25 of 188)

Practitioners 92

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Neumann Boever, O.D.

  • Optometrist
  • Lincoln, NE
  • NPI 1184646127
  NPD
• Gregory P Gerdes, OD

  • Optometrist
  • Omaha, NE
  • NPI 1497707244
  NPD
• Michael Jerome Johnson, O.D.

  • Optometrist
  • Watertown, SD
  • NPI 1548204191
  NPD
• Jarod S Kastl, O.D.

  • Optometrist
  • Norfolk, NE
  • NPI 1285685438
  NPD
• Jason Arthur Lorenz, O.D.

  • Optometrist
  • Aberdeen, SD
  • NPI 1619918216
  NPD
• Anthony James Manthey, O.D.

  • Optometrist
  • Lincoln, NE
  • NPI 1669423869
  NPD
• Matthew Porn, O.D.

  • Optometrist
  • Lincoln, NE
  • NPI 1659752368
  NPD
• Robert David Sanders, O.D.

  • Sports Vision Optometrist
  • Lincoln, NE
  • NPI 1144273327
  NPD
• Russell Smith, O.D.

  • Optometrist
  • Bellevue, NE
  • NPI 1285687442
  NPD
• Mark Jay Witte, O.D.

  • Optometrist
  • Omaha, NE
  • NPI 1699714964
  NPD
• Lori Lee Aaron, CPHT

  • Pharmacy Technician
  • Redding, CA
  • NPI 1811310089
  NPD (past)
• Duane Allen, R.PH.

  • Pharmacist
  • Kalkaska, MI
  • NPI 1770030488
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1528010642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2610 BRIDGE AVE",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072075",
            "telephone_number": "507-373-2269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2610 BRIDGE AVE",
            "city": "ALBERT LEA",
            "state": "MN",
            "postal_code": "560072075",
            "telephone_number": "507-373-2269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT HEALTH SERVICES",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN MA FIRST PLAN OF MN",
            "identifier": "30328SH",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL VISION ADMIN.",
            "identifier": "410985054-4060",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS",
            "identifier": "42496",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIP",
            "identifier": "014060",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN MA MEDICA CHOICE CARE",
            "identifier": "21000715",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "35466",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN HEALTH PARTNERS",
            "identifier": "36059",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN MA PRIMEWEST HEALTH",
            "identifier": "03092036206",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "17831",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BLUE PLUS CARE",
            "identifier": "30329SH",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "CP2230-17",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Optical 060",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Senholtz
• Edward Reece Shaman, M.D.
• Leonard Edward Shelhamer Jr., M.D.
• Christopher Niles Shoff, D.C.
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 060)
• Shoptikal LLC (Shopko Optical 4236)
• Judy Jo Sibilrud, RN CNP
• Della Kay Simmons, O.D.
• Andrea Sue Simon, RN
• Melissa Julia Skime, P.A.-C.

• Eyewear Supplier in Albert Lea, MN
• Providers in Albert Lea, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; 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.