1. Home
  2. Directory
  3. Wisconsin
  4. De Pere
  5. Eyewear Supplier
  6. NPI Profile

SHOPKO OPTICAL 005
NPI 1407808496
Eyewear Supplier in De Pere, WI

Active since May 17, 2006
230 N WISCONSIN ST, DE PERE, WI 54115(920) 336-3390 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Shopko Optical 005 NPPES

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

SHOPKO OPTICAL 005 (NPI 1407808496) is a healthcare organization registered as an eyewear supplier in De Pere, 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

NPI1407808496
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address230 N WISCONSIN STDe Pere, WI 54115-2735
Mailing Address230 N Wisconsin StDe Pere, WI 54115-2735 · (920) 336-3390
Phone(920) 336-3390
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 11, 2008
✔ NPI 1407808496 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.
230 N WISCONSIN ST, De Pere, WI 54115
Open in Google Maps ↗

Other Names 1

Doing Business AsShopko Optical 005

Other Identifiers 9

Medicare PINDF0804
Other014005Vip
OtherCP2230-70Eyemed
Medicaid38428900WI
Other17637Medicare
Other42523Davis
Medicare ID-Type Unspecified0154160092
Other410985054-4005Nva
Medicare NSC5695760096WI

Other Providers at the Same Location NPPES 6

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

DR. AMY MARIE PEOT OD
Optometrist
230 N WISCONSIN ST
DE PERE, WI 54115
Brown County (920) 336-3390
ANN M MILLIGAN RPH
Pharmacist (Pharmacotherapy)
230 N WISCONSIN ST
DE PERE, WI 54115
Brown County (920) 336-2323
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
230 N WISCONSIN ST
DE PERE, WI 54115
Brown County (920) 336-2323
MR. THOMAS MERRILL THOMAS R.PH.
Pharmacist (Pharmacotherapy)
230 N WISCONSIN ST
DE PERE, WI 54115
Brown County (920) 336-2323
DR. NICHOLAS ROOVERS OD
Optometrist
230 N WISCONSIN ST
DE PERE, WI 54115
Brown County (920) 336-3390
KENNETH WILLIAM BOND
Pharmacist
230 N WISCONSIN ST
DE PERE, WI 54115
Brown County (920) 336-2323

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 1407808496. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 005.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 230 N Wisconsin St, De Pere, WI 54115. The listed phone number is (920) 336-3390.

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 11, 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.