Shopko Stores Operating Co LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

Shopko Optical 788

Practice address

200 Commerce Dr
Columbus, WI 53925

Phone

(920) 429-7137

NPI assigned

Jul 19, 2012

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 788 Doing business as

Locations

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

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1821343401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 COMMERCE DR",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "53925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COMMERCE DR",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "53925",
            "telephone_number": "920-429-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-27",
        "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 788",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kayla Sharpee, DPT
• Sharrow Drugs, Inc
• Nicholas L Sharrow, RPH
• Elisabeth Leanne Sherman
• Shopko Stores Operating Co LLC (Shopko Pharmacy 788)
• Emma Noelle Sowieja
• St. Marys Dean Ventures, Inc (Dean Clinic Columbus Family & Sports Orthopedic Center)
• Elisa Ann Talbot, L.P.N.
• Gabrielle Taschwer
• Katherine F Taylor

• Eyewear Supplier in Columbus, WI
• Providers in Columbus, 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 27, 2012; 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.