Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 035
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
2820 HIGHWAY 63 S, ROCHESTER, MN 55904-5571
(507) 281-0687
Mailing address
2820 HIGHWAY 63 S, ROCHESTER, MN 55904-5571
(507) 281-0687
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014035
VIP
—
01
—
17825
MEDICARE
—
01
—
20019120523
MN MA PRIMEWEST HEALTH
—
01
—
213121-15
EYEMED
—
01
—
35471
AVESIS
—
01
—
36055
MN HEALTH PARTNERS
—
01
—
39687SH
MN MA FIRST PLAN OF MN
—
01
—
39701SH
MN MA FIRST PLAN OF MN
—
01
—
42617
DAVIS
—
Enumeration date
05/17/2006
Last updated
04/15/2008
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