Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Optical 504
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
W3208 VAN ROY RD, APPLETON, WI 54915
(920) 111-1111
Mailing address
W3208 VAN ROY RD, APPLETON, WI 54915
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1114100518
ANTHEM BCBS WI
—
01
—
300133
EYEMED
—
05
—
38461200
—
WI
01
—
59715
DAVIS
—
01
—
60677
SPECTERA
—
Enumeration date
12/10/2007
Last updated
07/17/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us