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SHOPKO OPTICAL 002
NPI 1093767139
Eyewear Supplier in Green Bay, WI

Active since May 17, 2006
301 BAY PARK SQ, GREEN BAY, WI 54304(920) 499-3511 Get Directions Write a Review

NPPES record last updated: February 8, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 002 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHOPKO OPTICAL 002 (NPI 1093767139) is a healthcare organization registered as an eyewear supplier in Green Bay, Wisconsin and active in the NPI registry since May 2006. The organization lists Michael J Bettiga, Sr. Vice President Health Services, as its authorized official.

NPPES Registry Identity

NPI1093767139
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address301 BAY PARK SQGreen Bay, WI 54304-5104
Mailing Address301 Bay Park SqGreen Bay, WI 54304-5104 · (920) 499-3511
Phone(920) 499-3511
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 8, 2008
✔ NPI 1093767139 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEyewear SupplierSuppliers
Taxonomy Code332H00000X
Definition
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
301 BAY PARK SQ, Green Bay, WI 54304
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Other Names 1

Doing Business AsShopko Optical 002

Other Identifiers 9

OtherCP2230-69Eyemed
Medicare ID-Type Unspecified0154160086
Other17635Medicare
Other42501Davis
Other014002Vip
Medicare PINDF0804
Other410985054-4002Nva
Medicaid38410200WI
Medicare NSC5695760112

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 499-5889
SHOPKO
Pharmacy (Community/Retail Pharmacy)
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 499-5889
JAMES CHARLES FORNES , OD O.D.
Optometrist
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 499-3511
ELAINE M SMITH PA
Physician Assistant
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 592-9475
ALISYN R BACIAK PHARM.D.
Pharmacist
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 499-5889
THOMAS BOUCHER
Pharmacist
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 499-5889
DEBRA ANN CHRISTENSEN APNP
Nurse Practitioner (Family)
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 592-9475
MARISSA LEIGH ZEHREN APNP
Nurse Practitioner (Family)
301 BAY PARK SQ
GREEN BAY, WI 54304
Brown County (920) 592-9475

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shopko Stores Operating Co. LLC's NPI number?

The NPI number for Shopko Stores Operating Co. LLC is 1093767139. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 002.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 301 Bay Park Sq, Green Bay, WI 54304. The listed phone number is (920) 499-3511.

What is Shopko Stores Operating Co. LLC's specialty?

The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.

When was this NPI record last updated?

The NPPES record for Shopko Stores Operating Co. LLC was last updated on February 8, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.