Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 172
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
3400 N 27TH ST, LINCOLN, NE 68521-1314
(402) 465-5577
Mailing address
3400 N 27TH ST, LINCOLN, NE 68521-1314
(402) 465-5577
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014172
VIP
—
01
—
086109
MEDICARE
—
01
—
17891
MEDICARE
—
01
—
35499
AVESIS
—
05
—
41098505455
—
NE
01
—
42627
DAVIS
—
01
—
CP2230-26
EYEMED
—
Enumeration date
05/16/2006
Last updated
02/11/2008
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