Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 045
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
601 GALVIN RD S, BELLEVUE, NE 68005-2249
(402) 293-1840
Mailing address
601 GALVIN RD S, BELLEVUE, NE 68005-2249
(402) 293-1840
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003340
BLOCK
—
01
—
014045
VIP
—
05
—
10025073800
—
NE
01
—
17885
MEDICARE
—
01
—
213121-22
EYEMED
—
01
—
35495
AVESIS
—
01
—
35861
DAVIS
—
Enumeration date
05/16/2006
Last updated
02/11/2008
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