Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Optical 602
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
126 CHARLES ST, OCONTO, WI 54153-9446
(920) 834-1111
(920) 834-9801
Mailing address
126 CHARLES ST, OCONTO, WI 54153-9446
(920) 834-1111
(920) 834-9801
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
05/19/2010
Last updated
07/26/2011
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