Shopko Stores Operating Co.,LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPKO STORES OPERATING CO.,LLC

Doing business as

Shopko Optical 789

Practice address

825 W Fulton St
Waupaca, WI 54981-1471

Phone

(715) 258-9000

Fax

(715) 258-4119

NPI assigned

Mar 6, 2013

Last updated

Mar 6, 2013By 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 Bettiga, RPH

Title

Executive Vice President and Coo

Phone

92042949297

Specialties & licenses 1

Addresses

Other names 1

• SHOPKO OPTICAL 789 Doing business as

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

{
    "created_epoch": "1362528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362528000000",
    "number": "1952642589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 W FULTON ST",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811471",
            "telephone_number": "715-258-9000",
            "fax_number": "715-258-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 W FULTON ST",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811471",
            "telephone_number": "715-258-9000",
            "fax_number": "715-258-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO.,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-06",
        "last_updated": "2013-03-06",
        "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": "92042949297",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPKO OPTICAL 789",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert William Sedlacek, M.D.
• Wendy Lynn Seegers
• Holly Marie Sherman, CNM
• Shopko Stores Operating Co LLC (Shopko Pharmacy 789)
• Shopko Stores Operating Co LLC (Shopko Pharmacy 510)
• Shoptikal LLC (Shopko Optical 4250)
• Debra Kay Skyrms, NCC LPC
• Ella Marie Slager, COTA
• Sleep Health Wisconsin LLC
• Paul William Sletten, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.