Organization
SHOPKO STORES, INC.
Active
Other names
ShopKo Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
700 PILGRIM WAY, GREEN BAY, WI 54304-5263
(920) 429-4218
(920) 429-5218
Mailing address
PO BOX 19060, GREEN BAY, WI 54307-9060
(920) 429-4218
(920) 429-5218
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
06/17/2006
Last updated
08/22/2020
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