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SHOPKO OPTICAL 502
NPI 1861445405
Eyewear Supplier in Green Bay, WI

Active since May 17, 2006
2585 LINEVILLE RD, GREEN BAY, WI 54313(920) 662-9450 Get Directions Write a Review

NPPES record last updated: February 11, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Optical 502 NPPES

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

SHOPKO OPTICAL 502 (NPI 1861445405) 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

NPI1861445405
Entity TypeOrganization
Primary Taxonomy332H00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address2585 LINEVILLE RDGreen Bay, WI 54313-7122
Mailing Address2585 Lineville RdGreen Bay, WI 54313-7122 · (920) 662-9450
Phone(920) 662-9450
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 17, 2006
Last NPPES UpdateFebruary 11, 2008
✔ NPI 1861445405 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.
2585 LINEVILLE RD, Green Bay, WI 54313
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Other Names 1

Doing Business AsShopko Optical 502

Other Identifiers 9

Medicaid38723100WI
Other50115Davis
Medicare NSC5695760021WI
Other014502Vip
Other410985054-4502Nva
Other25866Medicare
Medicare PINDF0804
Medicare ID-Type Unspecified0154160300
OtherCP2230-71Eyemed

Other Providers at the Same Location NPPES 4

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

MR. DARRIN D WIRKES R.PH.
Pharmacist
2585 LINEVILLE RD, SHOPKO EXPRESS #502
GREEN BAY, WI 54313
Brown County (920) 662-9450
ORLANDO SIERRALTA
Pharmacist
2585 LINEVILLE RD
GREEN BAY, WI 54313
Brown County (920) 662-9450
DR. DAVID CLARK LIEBURN O.D.
Optometrist
2585 LINEVILLE RD
GREEN BAY, WI 54313
Brown County (920) 662-9450
SHOPKO STORES OPERATING CO LLC
Pharmacy (Community/Retail Pharmacy)
2585 LINEVILLE RD
GREEN BAY, WI 54313
Brown County (920) 662-9450

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 1861445405. It was assigned to this organization in the NPPES registry on May 17, 2006. The provider is doing business as Shopko Optical 502.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 2585 Lineville Rd, Green Bay, WI 54313. The listed phone number is (920) 662-9450.

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.