| NPI | 1417513896 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 4075 |
| Entity Type | Organization |
| Authorized Contact | RUSSELL STEINHORST CEO 920-429-7489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2019-11-20 |