Organization
SHOPKO STORES OPERATING,CO.,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD DEWEY OLSON O.D. (OPTOMOTRIST)
(608) 222-9420
Entity
Organization
Contact information
Practice address
6218 TRAIL RIDGE CT, OREGON, WI 53575-2534
(608) 222-9420
(608) 222-0578
Mailing address
6218 TRAIL RIDGE CT, OREGON, WI 53575-2534
(608) 222-9420
(608) 222-0578
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1772
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38416300
—
WI
Enumeration date
05/15/2006
Last updated
08/22/2020
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