Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 059
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
1001 HIGHWAY 15 S, FAIRMONT, MN 56031-4456
(507) 238-9490
Mailing address
1001 HIGHWAY 15 S, FAIRMONT, MN 56031-4456
(507) 238-9490
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014059
VIP
—
01
—
03092036205
MN MA PRIMEWEST HEALTH
—
01
—
17830
MEDICARE
—
01
—
35469
AVESIS
—
01
—
36058
MN HEALTH PARTNERS
—
01
—
3C159SH
MN MA FIRST PLAN OF MN
—
01
—
3C391SH
MN MA FIRST PLAN OF MN
—
01
—
42493
DAVIS
—
01
—
CP2230-19
EYEMED
—
Enumeration date
05/18/2006
Last updated
04/15/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us