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SHOPKO OPTICAL 004
NPI 1649223413
Eyewear Supplier in Green Bay, WI

Active since May 19, 2006
2430 E MASON ST, GREEN BAY, WI 54302(920) 468-4642 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shopko Optical 004 NPPES

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

SHOPKO OPTICAL 004 (NPI 1649223413) 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

NPI1649223413
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2430 E MASON STGreen Bay, WI 54302-3759
Mailing Address2430 E Mason StGreen Bay, WI 54302-3759 · (920) 468-4642
Phone(920) 468-4642
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateFebruary 11, 2008
✔ NPI 1649223413 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.
2430 E MASON ST, Green Bay, WI 54302
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Other Names 1

Doing Business AsShopko Optical 004

Other Identifiers 8

Other17636Medicare
Medicare PINDF0804
Medicaid38403100WI
Medicare ID-Type Unspecified0154160163
Other014004Vip
Other42520Davis
Medicare NSC5695760097WI
Other410985054-4004Nva

Other Providers at the Same Location NPPES 11

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)
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 468-6044
LYNN MARIE BOND PHARMACIST
Pharmacist
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 468-6044
MS. CHRISTINE A THOMAS RPH
Pharmacist
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 468-6044
SUSAN GILSON PHARM D
Pharmacist
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 468-6044
JENNIFER ANN LENIUS PA-C
Physician Assistant
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 406-9863
GAIL P BOSCO PA
Physician Assistant (Medical)
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 406-9863
JOHN RICHARD HOFMANN PHARMACIST
Pharmacist
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 468-6044
MR. JAMES L SCHMONSKY III OD
Optometrist
2430 E MASON ST
GREEN BAY, WI 54302
Brown County (920) 468-4642

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 1649223413. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Optical 004.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2430 E Mason St, Green Bay, WI 54302. The listed phone number is (920) 468-4642.

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.