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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Optical 179
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
5630 ST CROIX TRAIL, NORTH BRANCH, MN 55056
(651) 674-9951
(651) 674-9907
Mailing address
5630 ST CROIX TRAIL, NORTH BRANCH, MN 55056
(651) 674-9951
(651) 674-9907
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689835647
—
MN
Enumeration date
06/23/2008
Last updated
06/18/2009
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