Organization Name: | SHOPKO STORES OPERATING CO. LLC |
NPI Number: | 1013960723 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL J BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
Mailing Address: | 616 W Johnson St Fond Du Lac |
State: | WI US |
Postal Code: | 549353134 |
Phone Number: | 9209218290 |
Fax Number: | |
NPI Enumeration Date: | 05/17/2006 |
NPI Last Update Date: | 02/11/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332H00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
Taxonomy Specialization: | |
Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |