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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Optical 098
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2815 CHAD DR, EUGENE, OR 97408-7335
(541) 686-0838
Mailing address
2815 CHAD DR, EUGENE, OR 97408-7335
(541) 686-0838
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004379
—
OR
01
—
014098
VIP
—
01
—
42581
DAVIS VISION
—
01
—
CP2230-35
EYEMED
—
01
—
OR04942
NORIDIAN SUBMITTER ID
OR
Enumeration date
05/12/2006
Last updated
07/10/2008
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