| NPI | 1114100518 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 504 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BETTIGA Sr. Vice President Health Services 920-429-4297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2008-07-17 |