Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 094
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
955 BAILEY HILL RD, EUGENE, OR 97402-5486
(541) 686-0857
Mailing address
955 BAILEY HILL RD, EUGENE, OR 97402-5486
(541) 686-0857
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006929
—
OR
01
—
014094
VIP
—
01
—
42576
DAVIS VISION
—
01
—
CP2230-34
EYEMED
—
05
—
OMAP
—
OR
Enumeration date
05/12/2006
Last updated
08/22/2020
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