| NPI | 1386696383 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 122 |
| 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) |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-06-05 |