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Organization
SHOPKO STORES OPERATING CO. LLC
Active
Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 023
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
125 MAIN ST N, HUTCHINSON, MN 55350-1807
(320) 587-4945
Mailing address
125 MAIN ST N, HUTCHINSON, MN 55350-1807
(320) 587-4945
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014023
VIP
—
01
—
03092036203
MN MA PRIMEWEST HEALTH
—
01
—
17823
MEDICARE
—
01
—
1C942SH
MN MA FIRST PLAN OF MN
—
01
—
1C943SH
MN MA FIRST PLAN OF MN
—
01
—
2100134
MN MA MEDICA CHOICE CARE
—
01
—
35720
MN HEALTH PARTNERS
—
01
—
42609
DAVIS
—
01
—
CP2230-20
EYEMED
—
Enumeration date
05/17/2006
Last updated
04/15/2008
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