Organization
SHOPKO STORES OPERATING COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES L SCHMONSKY III OD (OPTOMETRIST)
(920) 468-4642
Entity
Organization
Contact information
Practice address
2430 E MASON ST, GREEN BAY, WI 54302-3759
(920) 468-4642
(920) 468-3490
Mailing address
2430 E MASON ST, GREEN BAY, WI 54302-3759
(920) 468-4642
(920) 468-3490
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1643-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38403100
—
WI
Enumeration date
05/11/2006
Last updated
08/22/2020
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