Organization
SHOPKO STORES OPERATING CO.,LLC
Active
Other names
SHOPKO OPTICAL 789
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
92042949297
Entity
Organization
Contact information
Practice address
825 W FULTON ST, WAUPACA, WI 54981-1471
(715) 258-9000
(715) 258-4119
Mailing address
825 W FULTON ST, WAUPACA, WI 54981-1471
(715) 258-9000
(715) 258-4119
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
03/06/2013
Last updated
03/06/2013
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