Organization
SHOPKO STORES OPERATING CO. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
3044 S 84TH ST STE 1, OMAHA, NE 68124-3208
(402) 391-1143
Mailing address
3044 S 84TH ST STE 1, OMAHA, NE 68124-3208
(402) 391-1143
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007124
BLOCK
—
01
—
014044
VIP
—
01
—
17884
MEDICARE
—
01
—
260474
MEDICARE
—
01
—
35504
AVESIS
—
01
—
35860
DAVIS
—
05
—
41098505418
—
NE
01
—
CP2230-31
EYEMED
—
Enumeration date
05/16/2006
Last updated
10/10/2017
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