Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 164
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
255 JOHN F KENNEDY RD, DUBUQUE, IA 52002-5313
(563) 583-5895
Mailing address
255 JOHN F KENNEDY RD, DUBUQUE, IA 52002-5313
(563) 583-5895
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014164
VIP
—
05
—
025-6347
—
IA
01
—
17711
MEDICARE
—
01
—
35437
AVESIS
—
01
—
70091
MEDICARE
—
01
—
OP1541
EYEMED
—
Enumeration date
05/17/2006
Last updated
02/11/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up