| NPI | 1114970985 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 108 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BETTIGA Sr. Vice President Health Services 920-429-4297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist Optician | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-07-10 |