Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 080
Organization subpart
No
Provider details
NPI number
Authorized official
DILIP SEDANI (VP)
(920) 429-7688
Entity
Organization
Contact information
Practice address
2201 ZEIER RD, MADISON, WI 53704
(608) 246-2161
Mailing address
2201 ZEIER RD, MADISON, WI 53704-7415
(608) 246-2161
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000087921
MEDICARE
—
01
—
014080
VIP
—
01
—
17657
MEDICARE
—
01
—
35574
AVESIS
—
05
—
38707300
—
WI
01
—
410985054-4080
NVA
—
01
—
42536
DAVIS
—
01
—
CP2230-78
EYEMED
—
Enumeration date
05/19/2006
Last updated
09/02/2018
About Stedi
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