Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 036
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
3708 HWY 63 N, ROCHESTER, MN 55906-3902
(507) 281-0657
Mailing address
3708 HWY 63 N, ROCHESTER, MN 55906-3902
(507) 281-0657
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17826
MEDICARE
—
01
—
20019120529
MN MA PRIMEWEST HEALTH
—
01
—
213121-16
EYEMED
—
01
—
35472
AVESIS
—
01
—
36056
MN HEALTH PARTNERS
—
01
—
411740865-4036
NATIONAL VISION ADMIN.
—
01
—
42619
DAVIS
—
01
—
64031SH
MN MA FIRST PLAN OF MN
—
Enumeration date
05/18/2006
Last updated
04/15/2008
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