Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Optical 608
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
1010 W RYAN ST, BRILLION, WI 54110-0000
(920) 756-2640
Mailing address
1010 W RYAN ST, BRILLION, WI 54110-0000
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
08/03/2011
Last updated
12/09/2011
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