Organization
SHOPKO STORES OPERATING CO. LLC
Active
Other names
ShopKo Optical 022
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
1900 N MAIN ST, MITCHELL, SD 57301-1160
(605) 996-7042
Mailing address
1900 N MAIN ST, MITCHELL, SD 57301-1160
(605) 996-7042
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014022
VIP
—
01
—
17910
MEDICARE
—
01
—
213121-27
EYEMED
—
01
—
35517
AVESIS
—
Enumeration date
05/18/2006
Last updated
02/11/2008
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