| NPI | 1164475752 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 064 |
| 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 | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2009-08-03 |