Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 038
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2208 N WEBB RD, GRAND ISLAND, NE 68803-1739
(308) 382-7661
Mailing address
2208 N WEBB RD, GRAND ISLAND, NE 68803-1739
(308) 382-7661
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014038
VIP
—
01
—
099548
MEDICARE
—
05
—
10025074000
—
NE
01
—
17882
MEDICARE
—
01
—
213121-23
EYEMED
—
01
—
35496
AVESIS
—
01
—
35858
DAVIS
—
01
—
914651
BLOCK
—
Enumeration date
05/16/2006
Last updated
02/11/2008
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