Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Optical 788
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
200 COMMERCE DR, COLUMBUS, WI 53925
(920) 429-7137
Mailing address
200 COMMERCE DR, COLUMBUS, WI 53925
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
07/19/2012
Last updated
07/27/2012
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