NPIMap

Organization Active NPI

Shopko Stores, Inc.

Doing business as ShopKo Optical

  • Eyewear Supplier
  • Green Bay, WI
National Provider Identifier
1649215666
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SHOPKO STORES, INC.
Doing business as
ShopKo Optical
Practice address
700 Pilgrim Way
Green Bay, WI 54304-5263
Phone
(920) 429-4218
Fax
(920) 429-5218
NPI assigned
Jun 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael J Bettiga, RPH
Title
Sr. Vice President Health Services
Phone
(920) 429-4297

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

700 Pilgrim Way
Green Bay, WI 54304-5263

Mailing address

PO Box 19060
Green Bay, WI 54307-9060
Phone (920) 429-4218

Other names 1

  • ShopKo Optical Doing business as

National Provider Directory

National Provider Directory

Locations

2610 Bridge Ave
Albert Lea, MN 56007
Phone (507) 373-2269

601 Galvin Rd S
Bellevue, NE 68005
Phone (402) 293-1840

2005 Krenzien Dr
Norfolk, NE 68701
Phone (402) 379-1434

1000 W Northland Ave
Appleton, WI 54914
Phone (866) 455-8111

2677 State Highway 53
Chippewa Fls, WI 54729
Phone (715) 726-1251

1771 Wisconsin Ave
Grafton, WI 53024
Phone (262) 375-0016

2430 E Mason St
Green Bay, WI 54302
Phone (920) 468-4642

4801 Washington Ave
Racine, WI 53406
Phone (262) 637-3733

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649215666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19060",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079060",
            "telephone_number": "920-429-4218",
            "fax_number": "920-429-5218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 PILGRIM WAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045263",
            "telephone_number": "920-429-4218",
            "fax_number": "920-429-5218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-08-22",
        "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_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",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.