Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 049
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
500 N HWY 281, ABERDEEN, SD 57401-1821
(605) 225-7677
Mailing address
500 N HWY 281, ABERDEEN, SD 57401-1821
(605) 225-7677
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014049
VIP
—
01
—
17911
MEDICARE
—
01
—
213121-26
EYEMED
—
01
—
35516
AVESIS
—
Enumeration date
05/18/2006
Last updated
02/11/2008
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