Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Optical 607
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
1010 SOUTH MAINLINE DR, SEYMOUR, WI 54165-1451
(920) 833-0430
Mailing address
1010 SOUTH MAINLINE DR, SEYMOUR, WI 54165-1451
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
07/21/2011
Last updated
10/17/2011
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