| Organization Name: | SHOPKO STORES OPERATING CO LLC |
| NPI Number: | 1689835647 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
| Mailing Address: | 5630 St Croix Trail North Branch |
| State: | MN US |
| Postal Code: | 55056 |
| Phone Number: | 6516749951 |
| Fax Number: | 6516749907 |
| NPI Enumeration Date: | 06/23/2008 |
| NPI Last Update Date: | 06/18/2009 |
| 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. |