| NPI | 1073565180 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 174 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BETTIGA Sr. Vice President Health Services 920-429-4297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-09-28 |