Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Optical 609
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1120 STATE ROAD 67, KEIL, WI 53042-1630
(920) 894-3604
Mailing address
1120 STATE ROAD 67, KEIL, WI 53042-1630
(920) 894-3604
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
08/03/2011
Last updated
11/03/2011
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