| NPI | 1225694748 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 4009 |
| Entity Type | Organization |
| Authorized Contact | RUSS STEINHORST EVP & CFO 920-429-7842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2024-11-29 |