Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 123
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
900 MEMORIAL RD, HOUGHTON, MI 49931-2481
(906) 487-9767
Mailing address
900 MEMORIAL RD, HOUGHTON, MI 49931-2481
(906) 487-9767
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014123
VIP
—
01
—
0P06340
MEDICARE
—
01
—
17876
MEDICARE
—
01
—
213121-10
EYEMED
—
01
—
35463
AVESIS
—
01
—
410985054-4123
NVA
—
01
—
42538
DAVIS VISION
—
Enumeration date
05/16/2006
Last updated
11/03/2015
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