Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 027
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
4801 WASHINGTON AVE, RACINE, WI 53406-4219
(262) 637-3733
Mailing address
4801 WASHINGTON AVE, RACINE, WI 53406-4219
(262) 637-3733
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014027
VIP
—
01
—
146151-1
EYEMED
—
01
—
17645
MEDICARE
—
05
—
38409300
—
WI
01
—
410985054-4027
NVA
—
01
—
42620
DAVIS
—
Enumeration date
05/17/2006
Last updated
02/11/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us