| NPI | 1669013256 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 4220 |
| Entity Type | Organization |
| Authorized Contact | JAMES EISEN Director 920-429-7549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2019-10-04 |