Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Optical 180
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
3271 MARKETPLACE DR, COUNCIL BLUFFS, IA 51501-7908
(712) 366-0706
(712) 366-9020
Mailing address
3271 MARKETPLACE DR, COUNCIL BLUFFS, IA 51501-7908
(712) 366-0706
(712) 366-9020
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135093
VIP
—
01
—
1366608440
WELLMARK BCBS IA
—
01
—
51451
AVESIS
—
01
—
62213
SPECTERA
—
01
—
A00793
EYEMED
—
Enumeration date
07/29/2008
Last updated
08/24/2009
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