Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 056
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
14445 W CENTER RD, OMAHA, NE 68144-5401
(402) 333-7462
Mailing address
14445 W CENTER RD, OMAHA, NE 68144-5401
(402) 333-7462
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009774
BLOCK
—
01
—
014056
VIP
—
01
—
092603
MEDICARE
—
01
—
17890
MEDICARE
—
01
—
35503
AVESIS
—
01
—
35866
DAVIS
—
05
—
41098505420
—
NE
01
—
CP2230-30
EYEMED
—
Enumeration date
05/16/2006
Last updated
02/11/2008
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