Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 042
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
1300 S KOELLER ST, OSHKOSH, WI 54902-6169
(920) 426-5730
Mailing address
1300 S KOELLER ST, OSHKOSH, WI 54902-6169
(920) 426-5730
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014042
VIP
—
01
—
17653
MEDICARE
—
01
—
35722
AVESIS
—
05
—
38425700
—
WI
01
—
410985054-4042
NVA
—
01
—
42595
DAVIS
—
01
—
CP2230-85
EYEMED
—
Enumeration date
05/17/2006
Last updated
02/11/2008
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